Provider Demographics
NPI:1689758526
Name:VALLE, HERMINIGILDO VILLON (MD)
Entity Type:Individual
Prefix:
First Name:HERMINIGILDO
Middle Name:VILLON
Last Name:VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:STE #510
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-991-7002
Mailing Address - Fax:650-991-3119
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:STE #510
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-991-7002
Practice Address - Fax:650-991-3119
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A501880OtherBLUE SHIELD
5422000A501880OtherBLUE SHIELD 1505
943153300002OtherAETNA
P00281697OtherRAILROAD MEDICARE
CA00A501881Medicaid
00A501880OtherHPSM CA
C00A501880OtherUNITED AMERICAN INS
PR59662820001OtherCIGNA
CA00A501881Medicaid
00A501880OtherHPSM CA