Provider Demographics
NPI:1407250640
Name:JULIA J. VALLE,D.D.S.,INC
Entity Type:Organization
Organization Name:JULIA J. VALLE,D.D.S.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-562-3224
Mailing Address - Street 1:133 S MIRAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-2541
Mailing Address - Country:US
Mailing Address - Phone:559-562-3224
Mailing Address - Fax:559-562-6440
Practice Address - Street 1:133 S MIRAGE AVE
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-2541
Practice Address - Country:US
Practice Address - Phone:559-562-3224
Practice Address - Fax:559-562-6440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JULIA J VALLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-17
Last Update Date:2014-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689913113Medicaid