Provider Demographics
NPI:1710303433
Name:GRUPO GINECOLOGICO SANTORO VALE
Entity Type:Organization
Organization Name:GRUPO GINECOLOGICO SANTORO VALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YARI
Authorized Official - Middle Name:
Authorized Official - Last Name:VALE- MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-672-8086
Mailing Address - Street 1:LA CUMBRE BOX 263
Mailing Address - Street 2:267 SIERRA MORENA ST
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-600-7798
Mailing Address - Fax:787-754-0935
Practice Address - Street 1:107 ORTEGON ST.
Practice Address - Street 2:CAPARRA GALLERY SUITE 312
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-600-7798
Practice Address - Fax:787-754-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16059207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty