Provider Demographics
NPI:1558552331
Name:VALLE, RON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:VALLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:7205 KEYESPORT WAY
Mailing Address - Street 2:
Mailing Address - City:DISCOVERY BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94505-1757
Mailing Address - Country:US
Mailing Address - Phone:925-389-6158
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 1265E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5814
Practice Address - Country:US
Practice Address - Phone:310-273-4843
Practice Address - Fax:310-273-5056
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY8615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558552331Medicaid