Provider Demographics
NPI:1700540911
Name:DE VALLE, CHRISTOPHER (CSA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DE VALLE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21150 CORAL BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5913
Mailing Address - Country:US
Mailing Address - Phone:281-913-9240
Mailing Address - Fax:
Practice Address - Street 1:710 CYPRESS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3402
Practice Address - Country:US
Practice Address - Phone:281-440-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
21-590246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
21-590OtherTHE AMERICAN BOARD OF SURGICAL ASSISTANTS