Provider Demographics
NPI:1053748475
Name:VALLA, JACOB JUDE (AUD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JUDE
Last Name:VALLA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W HARBOR DR UNIT 418
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7721
Mailing Address - Country:US
Mailing Address - Phone:585-802-9917
Mailing Address - Fax:
Practice Address - Street 1:500 W HARBOR DR UNIT 418
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7721
Practice Address - Country:US
Practice Address - Phone:585-802-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006315231H00000X
CAAU3261231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist