Provider Demographics
NPI:1528200144
Name:VALENI MASTECTOMY & WOMEN'S HEALTH SHOP INC.
Entity Type:Organization
Organization Name:VALENI MASTECTOMY & WOMEN'S HEALTH SHOP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
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 1:1631 CALLE COLORADO
Mailing Address - Street 2:URB. SAN GERARDO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3322
Mailing Address - Country:US
Mailing Address - Phone:787-798-7023
Mailing Address - Fax:787-758-7674
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:00959-6712
Practice Address - Country:US
Practice Address - Phone:787-798-7023
Practice Address - Fax:787-758-7674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5260190001Medicare UPIN