Provider Demographics
NPI:1497730733
Name:DELVALLE-BIASCOECHEA, CARLOS RAFAEL SR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RAFAEL
Last Name:DELVALLE-BIASCOECHEA
Suffix:SR
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:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0670
Mailing Address - Country:US
Mailing Address - Phone:787-796-4155
Mailing Address - Fax:787-626-4620
Practice Address - Street 1:410 CALLE MENDEZ VIGO
Practice Address - Street 2:SUITE 104
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4800
Practice Address - Country:US
Practice Address - Phone:787-796-4155
Practice Address - Fax:787-626-4620
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6189207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97569Medicare ID - Type Unspecified