Provider Demographics
NPI:1356102503
Name:SANTIAGO VALLE, ADALBERTO
Entity type:Individual
Prefix:
First Name:ADALBERTO
Middle Name:
Last Name:SANTIAGO VALLE
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 1:701 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2704
Mailing Address - Country:US
Mailing Address - Phone:254-661-3394
Mailing Address - Fax:
Practice Address - Street 1:701 S 11TH ST
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2704
Practice Address - Country:US
Practice Address - Phone:254-661-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider