Provider Demographics
NPI:1538981857
Name:MICHELLE VALLE AMARO
Entity type:Organization
Organization Name:MICHELLE VALLE AMARO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLE AMARO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:663-436-0282
Mailing Address - Street 1:440 W SAN YSIDRO BLVD # 433768
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AV. IGNACIO ZARAGOZA 2750-811
Practice Address - Street 2:PLAZA TOREO
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22044
Practice Address - Country:MX
Practice Address - Phone:664-676-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty