Michael Richard Vallo, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

G069087 Issued in CA

Practice address

1617 Broadway St
Vallejo, CA 94590-2406

Phone

(707) 556-3794

NPI assigned

Oct 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1912083650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 KING RD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949521008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 BROADWAY ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945902406",
            "telephone_number": "707-556-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLO",
        "first_name": "MICHAEL",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G069087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1617 Broadway St",
            "city": "Vallejo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945902406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vallejo Emergency Physicians Medical Group Inc.
• Vallejo Foot & Ankle Clinic
• Vallejo Open MRI Center
• Vallejo Optometry Group
• Vallejo Together
• Deborah C Valtierra, M.D.
• Vicki Viola Van Hanson, LMFT
• Michael J. Van Noord, MD
• Hanh Van
• Melissa Lam Vander Wal, M.D.

• General Practice Physician in Vallejo, CA
• Providers in Vallejo, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.