Basic Information
| Provider Information | |||||||||
| NPI: | 1457025652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIAN VALLE DO PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10811 NW 7TH ST APT 14 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331723795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057906267 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7100 W 20TH AVE STE G166 | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330161805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058350551 | ||||||||
| FaxNumber: | 3056967704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | VALLE | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE MBR | ||||||||
| AuthorizedOfficialTelephone: | 3057906267 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 021242800 | 05 | FL | MEDICAID |