Provider Demographics
NPI:1215952056
Name:VALLEJO-BROOKS, MIEL MARIE (MD)
Entity type:Individual
Prefix:
First Name:MIEL
Middle Name:MARIE
Last Name:VALLEJO-BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIEL
Other - Middle Name:MARIE
Other - Last Name:VALLEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5280
Mailing Address - Street 2:PATIENT BUSINESS SERVICES
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-5280
Mailing Address - Country:US
Mailing Address - Phone:408-885-7200
Mailing Address - Fax:
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:OB/GYN DEPT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77518207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A775180Medicaid
CA00A775180Medicaid
CAI07664Medicare UPIN