Provider Demographics
NPI:1659564094
Name:DEL VALLE HERNANDEZ, ERNESTO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:JOSE
Last Name:DEL VALLE HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 514
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4674
Mailing Address - Country:US
Mailing Address - Phone:407-303-5687
Mailing Address - Fax:407-303-0806
Practice Address - Street 1:2501 N ORANGE AVE STE 514
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4674
Practice Address - Country:US
Practice Address - Phone:407-303-5687
Practice Address - Fax:407-303-0806
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121285207XP3100X, 207X00000X
PR019705207XP3100X
PR11735-I208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty