Provider Demographics
NPI:1285826248
Name:DELVALLE, ANTOINETTE (DO)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:DELVALLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22521 AVENIDA EMPRESA STE 107
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2041
Mailing Address - Country:US
Mailing Address - Phone:949-888-4661
Mailing Address - Fax:949-888-3645
Practice Address - Street 1:22521 AVENIDA EMPRESA STE 107
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2041
Practice Address - Country:US
Practice Address - Phone:949-888-4661
Practice Address - Fax:949-888-3645
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics