Provider Demographics
NPI:1316380868
Name:VALLERA, VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:VALLERA
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 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:F282/2A WEST
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-9800
Mailing Address - Fax:612-273-9779
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:F282/2A WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-9800
Practice Address - Fax:612-273-9779
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN588602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry