Provider Demographics
NPI:1336188424
Name:VALLES, LUIS F (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:F
Last Name:VALLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STETSON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3364
Mailing Address - Country:US
Mailing Address - Phone:704-596-5606
Mailing Address - Fax:
Practice Address - Street 1:52 HAVEN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2929
Practice Address - Country:US
Practice Address - Phone:781-944-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71266208000000X
NC239598208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3054870Medicaid