Provider Demographics
NPI:1003906470
Name:VALENTIN, EDWIN (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 PLAZA CAMELIA
Mailing Address - Street 2:PRIMAVERA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6078
Mailing Address - Country:US
Mailing Address - Phone:787-755-1615
Mailing Address - Fax:
Practice Address - Street 1:AVE NOGAL 2 D 1
Practice Address - Street 2:LOMAS VERDES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-269-3741
Practice Address - Fax:787-798-8952
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83725Medicare ID - Type UnspecifiedPROVIDER NUMBER