Provider Demographics
NPI:1689998619
Name:VALLELUNGO, JOSHUA PAUL
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:PAUL
Last Name:VALLELUNGO
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 1:420 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3600
Mailing Address - Country:US
Mailing Address - Phone:985-732-0058
Mailing Address - Fax:
Practice Address - Street 1:420 AVENUE F
Practice Address - Street 2:LSU RURAL FAMILY MEDICINE RESIDENCY PROGRAM
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3600
Practice Address - Country:US
Practice Address - Phone:985-735-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.205187207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine