Provider Demographics
NPI:1578660684
Name:MELCHIOR PETER VALLONE
Entity Type:Organization
Organization Name:MELCHIOR PETER VALLONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELCHIOR
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:VALLONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:619-465-3200
Mailing Address - Street 1:5129 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5103
Mailing Address - Country:US
Mailing Address - Phone:619-465-3200
Mailing Address - Fax:619-465-3700
Practice Address - Street 1:5129 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5103
Practice Address - Country:US
Practice Address - Phone:619-465-3200
Practice Address - Fax:619-465-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2201213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E22010Medicaid
E2201Medicare PIN
CAT19172Medicare UPIN
0174270001Medicare NSC