Provider Demographics
NPI:1407975857
Name:PAUL S. VALLEJO, DPM, INC.
Entity Type:Organization
Organization Name:PAUL S. VALLEJO, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:VALLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-493-3524
Mailing Address - Street 1:16606 PENNARD LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1236
Mailing Address - Country:US
Mailing Address - Phone:909-822-2075
Mailing Address - Fax:866-389-5723
Practice Address - Street 1:410 W CENTRAL AVE
Practice Address - Street 2:204
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3014
Practice Address - Country:US
Practice Address - Phone:714-990-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4299213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91587Medicare UPIN