Provider Demographics
NPI:1285386854
Name:LUIS VALLEJO, M.D., INC.
Entity type:Organization
Organization Name:LUIS VALLEJO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:VALLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-655-7674
Mailing Address - Street 1:125 S CRESCENT DR APT 6
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3115
Mailing Address - Country:US
Mailing Address - Phone:281-655-7674
Mailing Address - Fax:
Practice Address - Street 1:125 S CRESCENT DR APT 6
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3115
Practice Address - Country:US
Practice Address - Phone:281-655-7674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty