Provider Demographics
NPI:1073219606
Name:VALLE, KARLA MARITZA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MARITZA
Last Name:VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8831 TANGERINE SKY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-7245
Mailing Address - Country:US
Mailing Address - Phone:562-416-1984
Mailing Address - Fax:562-416-1984
Practice Address - Street 1:8831 TANGERINE SKY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-7245
Practice Address - Country:US
Practice Address - Phone:702-213-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV193200000XMedicaid