Provider Demographics
NPI:1750550042
Name:REBECCA S. VALLA, MD
Entity type:Organization
Organization Name:REBECCA S. VALLA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:VALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-750-0130
Mailing Address - Street 1:915 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2517
Mailing Address - Country:US
Mailing Address - Phone:336-750-0130
Mailing Address - Fax:336-750-0073
Practice Address - Street 1:915 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2517
Practice Address - Country:US
Practice Address - Phone:336-750-0130
Practice Address - Fax:336-750-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35776251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2332752Medicare UPIN
2209010BMedicare PIN