Provider Demographics
NPI:1871182790
Name:LA VALLE, ALEX (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:ALEX
Middle Name:
Last Name:LA VALLE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PIRATES COVE WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3066
Mailing Address - Country:US
Mailing Address - Phone:760-901-8200
Mailing Address - Fax:
Practice Address - Street 1:1 PIRATES COVE WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3066
Practice Address - Country:US
Practice Address - Phone:760-291-5032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer