Provider Demographics
NPI:1669687679
Name:VALLERA, PATRICIA M
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:M
Last Name:VALLERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-3112
Mailing Address - Country:US
Mailing Address - Phone:614-370-8495
Mailing Address - Fax:
Practice Address - Street 1:2911 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2523
Practice Address - Country:US
Practice Address - Phone:614-370-8495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist