Provider Demographics
NPI:1235682816
Name:VALLE, ISMAEL JOSUE SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:JOSUE
Last Name:VALLE
Suffix:SR
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:A14 CALLE 4
Mailing Address - Street 2:URB. LA MONSERRATE
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-325-6091
Mailing Address - Fax:
Practice Address - Street 1:A14 CALLE 4
Practice Address - Street 2:URB LA MONSERRATE
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-325-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21127208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice