Provider Demographics
NPI:1023126430
Name:DEL VALLE DE TOMAS, PEDRO F (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:F
Last Name:DEL VALLE DE TOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 715 TORRE AUXILIO MUTUO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5022
Mailing Address - Country:US
Mailing Address - Phone:787-250-0125
Mailing Address - Fax:787-773-8008
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 715 TORRE AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-250-0125
Practice Address - Fax:787-773-8008
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG45177Medicare UPIN
PR88962Medicare ID - Type Unspecified