Provider Demographics
NPI:1538584677
Name:VALLE, RICARDO ALCIDES (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:ALCIDES
Last Name:VALLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 AIRLINE DR
Mailing Address - Street 2:SUITE 100-B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-3607
Mailing Address - Country:US
Mailing Address - Phone:713-634-1000
Mailing Address - Fax:
Practice Address - Street 1:1623 AIRLINE DR
Practice Address - Street 2:SUITE 100-B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-3607
Practice Address - Country:US
Practice Address - Phone:713-634-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant