Provider Demographics
NPI:1881053072
Name:ALEJANDRO-VALLE, CARMEN LAURA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:LAURA
Last Name:ALEJANDRO-VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727A 25TH ST APT B2
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2234
Mailing Address - Country:US
Mailing Address - Phone:201-282-7291
Mailing Address - Fax:201-433-5847
Practice Address - Street 1:727A 25TH STREET APT B2
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-282-7291
Practice Address - Fax:201-433-5847
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00050200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist