Provider Demographics
NPI:1831197623
Name:VALLE, IVETTE (MD)
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:VALLE
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 1:1435 W 49TH PL
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3197
Mailing Address - Country:US
Mailing Address - Phone:305-818-5637
Mailing Address - Fax:305-818-5639
Practice Address - Street 1:1435 W 49TH PL
Practice Address - Street 2:SUITE 400A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3197
Practice Address - Country:US
Practice Address - Phone:305-818-5637
Practice Address - Fax:305-818-5639
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94751208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI967Medicare UPIN
FL276124600Medicaid