Provider Demographics
NPI:1639124241
Name:VALLS, MARCOS
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:
Last Name:VALLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 FD ROOSEVELT
Mailing Address - Street 2:610 TORRE PLAZA LAS AMERICAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-759-8325
Mailing Address - Fax:787-751-1609
Practice Address - Street 1:610 TORRE PLAZA
Practice Address - Street 2:LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-759-8325
Practice Address - Fax:787-751-1609
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4534208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D08328Medicare UPIN
0025452Medicare ID - Type Unspecified