Provider Demographics
NPI:1164431896
Name:ROMAN VALE, JORGE ORLANDO (MD)
Entity Type:Individual
Prefix:MS
First Name:JORGE
Middle Name:ORLANDO
Last Name:ROMAN VALE
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:PO BOX 56
Mailing Address - Street 2:BO. MALPASO
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0056
Mailing Address - Country:US
Mailing Address - Phone:787-868-2365
Mailing Address - Fax:787-868-2365
Practice Address - Street 1:CARR 417 KM 3.0
Practice Address - Street 2:BO. MALPASO
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0056
Practice Address - Country:US
Practice Address - Phone:787-868-2365
Practice Address - Fax:787-868-2365
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15186208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH99111Medicare UPIN