Marvin Vallejo

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

68180 Issued in MN

Practice address

200 1St St SW
Rochester, MN 55905-0001

Phone

(507) 284-2511

NPI assigned

Apr 11, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1083078554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLEJO",
        "first_name": "MARVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D13719",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MN",
            "license": "29838",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MN",
            "license": "68180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Debra Valesano, D.D.S.
• Johnathan Valesano, MD
• Carlos Daniel Valladares Diaz, RN
• Katalina Elizabeth Valladares
• Tissiana Gabriela Menna Vallecillo, MD
• Amy Van Abel, PHARMD
• Kathryn McKinna Van Abel, MD
• Luke William Van Alstine, MD
• Camille Marguerit Van Buskirk, MD
• Matthew Van Cuyk, PHARMD

• Oral & Maxillofacial Surgery (D.M.D.) in Rochester, MN
• Providers in Rochester, MN by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.