Individual
CHANTEL ELA MAY VALLO VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 BROADWAY UNIT 639, SAN DIEGO, CA 92101-5757
(951) 306-9380
Mailing address
1601 BROADWAY UNIT 639, SAN DIEGO, CA 92101-5757
(951) 306-9380
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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