Provider Demographics
NPI:1073730750
Name:PALVAL MD'S PSC
Entity Type:Organization
Organization Name:PALVAL MD'S PSC
Other - Org Name:DR. MIGUEL PALACIOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-743-1415
Mailing Address - Street 1:VENTANAS DE GURABO
Mailing Address - Street 2:APTO. 263
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5301
Mailing Address - Country:US
Mailing Address - Phone:787-743-1415
Mailing Address - Fax:787-961-4662
Practice Address - Street 1:HIMA PLAZA 1
Practice Address - Street 2:500 AVE. DEGETAU STE 415
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7307
Practice Address - Country:US
Practice Address - Phone:787-743-1415
Practice Address - Fax:787-961-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6879174400000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE31508Medicare UPIN
PR27643PAMedicare ID - Type UnspecifiedMEDICARE