Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | E4299 | CA |
NPI | 1003927203 |
---|---|
Provider Name | Dr. Paul S. Vallejo |
First Address | Fontana, CA 92336-1236 |
Second Address | Brea, CA 92821-3014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U91587 | (02) | CA |