Provider Demographics
NPI:1407820657
Name:VALLEDOR MAESO, LUIS E SR (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:VALLEDOR MAESO
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:267 CALLE SIERRA MORENA
Mailing Address - Street 2:PMB 696
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-785-8981
Mailing Address - Fax:787-780-4866
Practice Address - Street 1:BAYAMON MEDICAL PLAZA
Practice Address - Street 2:SUITE 105
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-785-8981
Practice Address - Fax:787-780-4866
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2020-04-14
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Provider Licenses
StateLicense IDTaxonomies
PR11711207YX0905X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41773Medicare UPIN
PR0087627Medicare PIN