Provider Demographics
NPI:1497214431
Name:VALLE, LUIS E (DO)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:VALLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 FOOTHILL BLVD STE E237
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1456
Mailing Address - Country:US
Mailing Address - Phone:747-228-8944
Mailing Address - Fax:
Practice Address - Street 1:2813 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2611
Practice Address - Country:US
Practice Address - Phone:323-342-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine