Provider Demographics
NPI:1073636247
Name:DEL VALLE, ELBA
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:
Last Name:DEL VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A33 CALLE GARDENIA
Mailing Address - Street 2:LOIZA VALLEY
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3548
Mailing Address - Country:US
Mailing Address - Phone:787-220-1896
Mailing Address - Fax:787-769-5353
Practice Address - Street 1:800 AVE RAFAEL HDEZ MARIN
Practice Address - Street 2:STE 5 FARMACIA AMIGA DE MONTECARLO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5288
Practice Address - Country:US
Practice Address - Phone:787-762-1616
Practice Address - Fax:787-769-5353
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4105183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician