Provider Demographics
NPI:1265879332
Name:VALLA, NOREEN (MD)
Entity type:Individual
Prefix:DR
First Name:NOREEN
Middle Name:
Last Name:VALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E. US HIGHWAY 290
Mailing Address - Street 2:SUITE 420 - CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:2100 AUTUMN SLATE DR STE 150
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6034
Practice Address - Country:US
Practice Address - Phone:512-989-2680
Practice Address - Fax:512-406-7339
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364792704Medicaid
TX364792703Medicaid