Provider Demographics
NPI:1215071907
Name:DEL VALLE, ROSA M (MD)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:DEL VALLE
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 1:18027 MARTHA ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1052
Mailing Address - Country:US
Mailing Address - Phone:818-758-3447
Mailing Address - Fax:
Practice Address - Street 1:7542 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3148
Practice Address - Country:US
Practice Address - Phone:818-765-0503
Practice Address - Fax:818-765-3842
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48945208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489450Medicaid