Provider Demographics
NPI:1568500130
Name:VALLE IRIZARRY, HILDA L
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:L
Last Name:VALLE IRIZARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHALETS DE SANTA MARIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6635
Mailing Address - Country:US
Mailing Address - Phone:939-644-8319
Mailing Address - Fax:
Practice Address - Street 1:URB SAN AGUSTIN
Practice Address - Street 2:CALLE MAXIMO ALOMAR 1175
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-0092
Practice Address - Country:US
Practice Address - Phone:787-726-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist