Provider Demographics
NPI:1992016497
Name:VALLE, BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:VALLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10811 NW 7TH ST APT 14
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3795
Mailing Address - Country:US
Mailing Address - Phone:305-790-6267
Mailing Address - Fax:
Practice Address - Street 1:2100 W 68TH ST
Practice Address - Street 2:STE 202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1804
Practice Address - Country:US
Practice Address - Phone:305-364-2107
Practice Address - Fax:305-822-8347
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12576207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease