Provider Demographics
NPI:1790560142
Name:DEL VALLE BAEZ, CARLOS MANUEL
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:DEL VALLE BAEZ
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:CARRETERA #2 KM 80.4 BARRIO SAN DANIEL SEC. LAS CANELAS
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-878-5475
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #2 KM 80.4 BARRIO SAN DANIEL SEC. LAS CANELAS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614
Practice Address - Country:US
Practice Address - Phone:787-878-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program