Provider Demographics
NPI:1437155264
Name:BARBOSA DEL VALLE, EUGENIO RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIO
Middle Name:RAFAEL
Last Name:BARBOSA DEL VALLE
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:PMB 166, 405 ESMERALDA AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4457
Mailing Address - Country:US
Mailing Address - Phone:787-277-5477
Mailing Address - Fax:787-277-5476
Practice Address - Street 1:1476 AVE SAN IGNACIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4739
Practice Address - Country:US
Practice Address - Phone:787-277-5477
Practice Address - Fax:787-277-5476
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7776208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE39123Medicare UPIN
PR29779Medicare ID - Type Unspecified