Provider Demographics
NPI:1376895078
Name:VALDES-MONGE, JACKELINE (JACKELINE VALDES)
Entity Type:Individual
Prefix:DR
First Name:JACKELINE
Middle Name:
Last Name:VALDES-MONGE
Suffix:
Gender:F
Credentials:JACKELINE VALDES
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 191227
Mailing Address - Street 2:HOSP AUXILIO MUTUO, DEP MEDICINA INTERNA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE LUIS MUNOZ RIVERA
Practice Address - Street 2:HOSP AUXILIO MUTUO, DEP MEDICINA INTERNA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-1227
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13199208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice