Provider Demographics
NPI:1306301007
Name:DELVALLE, MILAGROS
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:DELVALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3211
Mailing Address - Country:US
Mailing Address - Phone:413-209-6551
Mailing Address - Fax:
Practice Address - Street 1:80 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-4704
Practice Address - Country:US
Practice Address - Phone:413-846-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACHW00389172V00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134107113Medicaid
MA12529OtherHNE
MA71756OtherTUFTS
MA1134107113OtherFALLON
MA1134107113OtherBEACON
MA997303OtherNETWORK HEALTH
MA1134107113OtherMBHP
MA042622756OtherCCA
MA1134107113OtherNHP
MAY10086OtherMEDICARE