Provider Demographics
NPI:1184036998
Name:DEL VALLE, MISAEL (MD)
Entity Type:Individual
Prefix:
First Name:MISAEL
Middle Name:
Last Name:DEL VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 PARK CENTER DR APT B1609
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1495
Mailing Address - Country:US
Mailing Address - Phone:305-467-8501
Mailing Address - Fax:
Practice Address - Street 1:9525 KATY FWY STE 206
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1476
Practice Address - Country:US
Practice Address - Phone:713-400-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD84789207L00000X
FLTRN# 20256207R00000X
TXS9675207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTRN# 20256OtherUNLICENSED INTERN/RESIDENT PHYSICIAN