Provider Demographics
NPI:1437878691
Name:VALLESILLO MARIN, MALLELY (CHW)
Entity Type:Individual
Prefix:
First Name:MALLELY
Middle Name:
Last Name:VALLESILLO MARIN
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SCHILLING PL BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4543
Mailing Address - Country:US
Mailing Address - Phone:831-755-4648
Mailing Address - Fax:
Practice Address - Street 1:1441 SCHILLING PL BLDG 1
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4543
Practice Address - Country:US
Practice Address - Phone:831-755-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator