Provider Demographics
NPI:1346571015
Name:VILLALUZ D.M.D., JOSEF VALLE (JOSEF VILLALUZ DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEF
Middle Name:VALLE
Last Name:VILLALUZ D.M.D.
Suffix:
Gender:M
Credentials:JOSEF VILLALUZ DMD
Other - Prefix:DR
Other - First Name:JOSEFINO
Other - Middle Name:VALLE
Other - Last Name:VILLALUZ D.M.D.
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:696 E SANTA CLARA ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1911
Mailing Address - Country:US
Mailing Address - Phone:408-287-4032
Mailing Address - Fax:408-287-4032
Practice Address - Street 1:696 E. SANTA CLARA STREET
Practice Address - Street 2:SUITE#201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-9512
Practice Address - Country:US
Practice Address - Phone:408-287-4032
Practice Address - Fax:408-287-4032
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB23703-01Medicaid