Provider Demographics
NPI:1578176905
Name:VALLE, BRANDON CALIO
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CALIO
Last Name:VALLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14551 W GELDING DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5757
Mailing Address - Country:US
Mailing Address - Phone:623-760-4012
Mailing Address - Fax:
Practice Address - Street 1:14551 W GELDING DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5757
Practice Address - Country:US
Practice Address - Phone:623-760-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program