Provider Demographics
NPI:1285281725
Name:VALLE, HECTOR JR (PA)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:VALLE
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7594 RIDGEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7331
Mailing Address - Country:US
Mailing Address - Phone:786-376-1013
Mailing Address - Fax:
Practice Address - Street 1:4733 W ATLANTIC AVE STE C8
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3706
Practice Address - Country:US
Practice Address - Phone:561-774-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant