Provider Demographics
NPI:1164644290
Name:VALLE-CAMPOS, NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:VALLE-CAMPOS
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:P. O. BOX 3872
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3872
Mailing Address - Country:US
Mailing Address - Phone:787-834-2136
Mailing Address - Fax:
Practice Address - Street 1:MAYAGUEZ MEDICAL CENTER
Practice Address - Street 2:PR-2, HOSTOS AVENUE
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-3872
Practice Address - Country:US
Practice Address - Phone:787-834-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90052084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine