Provider Demographics
NPI:1205369840
Name:VALLE, CHRISTIAN ANTONIO (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ANTONIO
Last Name:VALLE
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 1:3601 DESIARD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-4352
Mailing Address - Country:US
Mailing Address - Phone:318-397-1574
Mailing Address - Fax:
Practice Address - Street 1:3601 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4352
Practice Address - Country:US
Practice Address - Phone:318-397-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA322501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery