Provider Demographics
NPI:1912052382
Name:DELVALLE, JOSE MANUEL (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:DELVALLE
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:MANUEL
Other - Last Name:DEL VALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3918 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4105
Mailing Address - Country:US
Mailing Address - Phone:305-556-1770
Mailing Address - Fax:
Practice Address - Street 1:3918 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4105
Practice Address - Country:US
Practice Address - Phone:305-556-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN102691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice