Provider Demographics
NPI:1376661793
Name:VALENI MASTECTOMY WOMENS HEALTH
Entity Type:Organization
Organization Name:VALENI MASTECTOMY WOMENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LICEAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-798-7023
Mailing Address - Street 1:COLORADO ST. 1631
Mailing Address - Street 2:URB. SAN GERARDO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-798-7023
Mailing Address - Fax:508-682-0917
Practice Address - Street 1:SANTA ROSA MALL
Practice Address - Street 2:SUITE 202 B
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6710
Practice Address - Country:US
Practice Address - Phone:787-798-7023
Practice Address - Fax:508-682-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5260190001Medicare NSC