Provider Demographics
NPI:1093998965
Name:VALLONE, MELCHIOR P (DPM)
Entity Type:Individual
Prefix:
First Name:MELCHIOR
Middle Name:P
Last Name:VALLONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5103
Mailing Address - Country:US
Mailing Address - Phone:619-465-3200
Mailing Address - Fax:619-465-3700
Practice Address - Street 1:5129 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5103
Practice Address - Country:US
Practice Address - Phone:619-465-3200
Practice Address - Fax:619-465-3700
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2201213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000E22010OtherBC
756480533OtherRR MEDICARE
CA1165019Medicaid
0174270001Medicare NSC
CA1165019Medicaid