Individual
MR. ROBERT VALLE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDA84376
Contact information
Practice address
12121 WILSHIRE BLVD, LOS ANGELES, CA 90025-1123
(310) 820-9933
Mailing address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
(310) 820-9933
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
84376
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84376
—
CA
Enumeration date
09/03/2020
Last updated
09/03/2020
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