Provider Demographics
NPI:1093272767
Name:DELVALLE GOMEZ, RAQUEL (LCDA)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:DELVALLE GOMEZ
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 11954
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-9697
Mailing Address - Country:US
Mailing Address - Phone:939-242-3527
Mailing Address - Fax:787-953-3913
Practice Address - Street 1:65 CALLE SANTIAGO N
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2426
Practice Address - Country:US
Practice Address - Phone:939-242-3527
Practice Address - Fax:787-953-3913
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist