Provider Demographics
NPI:1376670463
Name:GRIPAL, FERDINAND VALLE (PT)
Entity type:Individual
Prefix:
First Name:FERDINAND
Middle Name:VALLE
Last Name:GRIPAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 ATLANTA DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7858
Mailing Address - Country:US
Mailing Address - Phone:956-725-3280
Mailing Address - Fax:956-725-6933
Practice Address - Street 1:6805 N. BARTLETT AVE.
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-753-3660
Practice Address - Fax:956-753-3670
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist