Provider Demographics
NPI:1285684217
Name:VALLE-OLIVERAS, JOSE WILFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:WILFREDO
Last Name:VALLE-OLIVERAS
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 548
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0548
Mailing Address - Country:US
Mailing Address - Phone:787-874-0460
Mailing Address - Fax:787-874-0125
Practice Address - Street 1:BALDORIOTY ST. A-9
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-874-0460
Practice Address - Fax:787-874-0125
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12243204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR890073Medicare ID - Type Unspecified
PRG61344Medicare UPIN