Provider Demographics
NPI:1912229154
Name:VALLEJO, DANIEL C (DNP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:VALLEJO
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732455
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2455
Mailing Address - Country:US
Mailing Address - Phone:915-215-4755
Mailing Address - Fax:915-594-3583
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-215-5310
Practice Address - Fax:915-215-8606
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662459363LF0000X
TXAP118938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily