Provider Demographics
NPI:1578684288
Name:DEL VALLE, OLGA I (4684929)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:I
Last Name:DEL VALLE
Suffix:
Gender:F
Credentials:4684929
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A10 CALLE 2
Mailing Address - Street 2:ESTANCIAS DEL LAGO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-4602
Mailing Address - Country:US
Mailing Address - Phone:787-747-7665
Mailing Address - Fax:
Practice Address - Street 1:A10 CALLE 2
Practice Address - Street 2:ESTANCIAS DEL LAGO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-4602
Practice Address - Country:US
Practice Address - Phone:787-747-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist