Provider Demographics
NPI:1225232598
Name:VALLE, ROXANA
Entity Type:Individual
Prefix:MRS
First Name:ROXANA
Middle Name:
Last Name: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:HC-02 BOX 15413
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-313-9284
Mailing Address - Fax:787-899-3111
Practice Address - Street 1:4 CALLE CONCORDIA
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2051
Practice Address - Country:US
Practice Address - Phone:787-899-4170
Practice Address - Fax:787-899-3111
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3640183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician