Provider Demographics
NPI:1558919035
Name:VALLIN, MARTHA ELENA (MS, CHW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELENA
Last Name:VALLIN
Suffix:
Gender:F
Credentials:MS, CHW
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ELENA
Other - Last Name:PEGUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12803 FOLKGLEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-3871
Mailing Address - Country:US
Mailing Address - Phone:832-512-9468
Mailing Address - Fax:
Practice Address - Street 1:9850 EMMETT F LOWRY EXPY STE C
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2001
Practice Address - Country:US
Practice Address - Phone:409-978-4216
Practice Address - Fax:409-978-4217
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator