Provider Demographics
NPI:1326010448
Name:DEL VALEE SEPULVEDA, EDWIN ALBERTO (DMD)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:ALBERTO
Last Name:DEL VALEE SEPULVEDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:EDWIN
Other - Middle Name:
Other - Last Name:DEL VALLE SEPULVEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:F 5 LA CASA BLANCA ST
Mailing Address - Street 2:PASEO SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-286-9025
Mailing Address - Fax:787-743-2985
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:SUITE 605 PARNA MEDICAL INSTITUTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1322
Practice Address - Country:US
Practice Address - Phone:787-841-7892
Practice Address - Fax:787-259-7514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41605DEMedicare ID - Type Unspecified