1689758526 NPI number — HERMINIGILDO VILLON VALLE MD

Table of content: (NPI 1073399473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689758526 NPI number — HERMINIGILDO VILLON VALLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALLE
Provider First Name:
HERMINIGILDO
Provider Middle Name:
VILLON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689758526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 SULLIVAN AVE
Provider Second Line Business Mailing Address:
STE #510
Provider Business Mailing Address City Name:
DALY CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-991-7002
Provider Business Mailing Address Fax Number:
650-991-3119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 SULLIVAN AVE
Provider Second Line Business Practice Location Address:
STE #510
Provider Business Practice Location Address City Name:
DALY CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-991-7002
Provider Business Practice Location Address Fax Number:
650-991-3119
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A50188 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A501880 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5422000A501880 . This is a "BLUE SHIELD 1505" identifier . This identifiers is of the category "OTHER".
  • Identifier: 943153300002 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00281697 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A501881 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A501880 . This is a "HPSM CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: C00A501880 . This is a "UNITED AMERICAN INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PR59662820001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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