Provider Demographics
NPI:1952370074
Name:DELVALLE VELEZ, JEANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:DELVALLE VELEZ
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 1:332 S JUNIPER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4941
Mailing Address - Country:US
Mailing Address - Phone:760-291-6604
Mailing Address - Fax:760-737-3430
Practice Address - Street 1:754 MEDICAL CENTER CT
Practice Address - Street 2:101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6654
Practice Address - Country:US
Practice Address - Phone:619-421-3313
Practice Address - Fax:619-421-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A426600Medicaid
CA00A426600Medicaid
CAWA42660GMedicare PIN