Provider Demographics
NPI:1225257710
Name:VALLE MEDICAL OFFICE PSC
Entity Type:Organization
Organization Name:VALLE MEDICAL OFFICE PSC
Other - Org Name:PROFFESIONAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:FACTURADORA
Authorized Official - Prefix:
Authorized Official - First Name:DARITZA
Authorized Official - Middle Name:SANCHEZ
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-314-3431
Mailing Address - Street 1:136 BDA CABAN
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9465
Mailing Address - Country:US
Mailing Address - Phone:787-997-1111
Mailing Address - Fax:
Practice Address - Street 1:136 BDA CABAN
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-9465
Practice Address - Country:US
Practice Address - Phone:787-997-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16009208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23314OtherMEDICARE PTAN