Provider Demographics
NPI:1598055881
Name:DELIZ DEL VALLE, MAYLISSA (DC)
Entity Type:Individual
Prefix:
First Name:MAYLISSA
Middle Name:
Last Name:DELIZ DEL VALLE
Suffix:
Gender:F
Credentials:DC
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 372533
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2533
Mailing Address - Country:US
Mailing Address - Phone:787-694-7878
Mailing Address - Fax:
Practice Address - Street 1:3 CARR 14 # KM
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3714
Practice Address - Country:US
Practice Address - Phone:787-694-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor