Provider Demographics
NPI:1073509642
Name:VALLE, LISA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:VALLE
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Gender:F
Credentials:DO
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Mailing Address - Street 1:1112 MONTANA AVE STE 378
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-7218
Mailing Address - Country:US
Mailing Address - Phone:424-231-7116
Mailing Address - Fax:310-496-2762
Practice Address - Street 1:1349 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2603
Practice Address - Country:US
Practice Address - Phone:424-231-7116
Practice Address - Fax:310-496-2762
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-05-09
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Provider Licenses
StateLicense IDTaxonomies
CA20A8420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI41660Medicare UPIN
CAW20A8420AMedicare PIN