Provider Demographics
NPI:1699146167
Name:DEL VALLE, IVELIS
Entity type:Individual
Prefix:
First Name:IVELIS
Middle Name:
Last Name:DEL VALLE
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 1:15 DAVENPORT AVE
Mailing Address - Street 2:5H
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3444
Mailing Address - Country:US
Mailing Address - Phone:914-584-6893
Mailing Address - Fax:
Practice Address - Street 1:15 DAVENPORT AVE
Practice Address - Street 2:5H
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3444
Practice Address - Country:US
Practice Address - Phone:914-584-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322917164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse