Provider Demographics
NPI:1558386722
Name:DEL VALLE, LUIS ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:DEL VALLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301ST / BO COROZO
Mailing Address - Street 2:7.3 KM
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-255-0798
Mailing Address - Fax:787-255-0798
Practice Address - Street 1:50 CALLE HENNA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3450
Practice Address - Country:US
Practice Address - Phone:787-254-0893
Practice Address - Fax:787-254-0893
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4157207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR96579Medicare ID - Type UnspecifiedMEDICARE