Individual provider Active NPI

Cory Allison Vallance, PA-C

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1710104062
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
19137 Issued in CA
Practice address
1075 Camino del Rio S
San Diego, CA 92108-3538
Phone
(619) 881-4500
NPI assigned
Apr 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 19137 CA Primary

Addresses

Primary practice location

1075 Camino del Rio S
San Diego, CA 92108-3538

Mailing address

2970 Havasupai Ave
San Diego, CA 92117-1641
Phone (858) 412-6161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120822000701 CA Practitioner - Physician Assistant 7719134907 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
19137CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Skilled Facility Health Care Solutions Inc CurrentSince Jun 16, 2012 Accepting new patients
Skilled Facility Health Care Solutions Inc CurrentSince Jun 16, 2012 Accepting new patients
Caring Hearts Medical Foundation and Health Services Inc Past Accepting new patients

Locations

875 N Brea Blvd
Brea, CA 92821
Phone (714) 529-6842

1100 Trousdale Dr
Burlingame, CA 94010
Phone (650) 692-1967

238 Virginia Ave
Campbell, CA 95008
Phone (408) 378-8114

3746 Foothill Blvd
La Crescenta, CA 91214
Phone (323) 574-0387

12021 Wilshire Blvd
Los Angeles, CA 90025
Phone (310) 348-1900

1790 Muir Rd
Martinez, CA 94553
Phone (925) 228-8383

1300 N C St
Oxnard, CA 93030
Phone (805) 983-0305

6401 33rd St
Riverside, CA 92509
Phone (909) 681-2200

2121 Pine St
San Francisco, CA 94115
Phone (415) 922-5085

3880 Via Lucero
Santa Barbara, CA 93110
Phone (805) 682-5208

1340 15th St
Santa Monica, CA 90404
Phone (310) 451-9700

585 Nut Tree Ct
Vacaville, CA 95687
Phone (707) 449-8000

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/swc_skilledfacilityhealthcaresolutions

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1710104062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2970 HAVASUPAI AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921171641",
            "telephone_number": "858-412-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 CAMINO DEL RIO S",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083538",
            "telephone_number": "619-881-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLANCE",
        "first_name": "CORY",
        "middle_name": "ALLISON",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "19137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.