Provider Demographics
NPI:1245323187
Name:DEL VALLE BALAGUER, CARLOS GUILLERMO (MD)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:GUILLERMO
Last Name:DEL VALLE BALAGUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:CARLOS
Other - Middle Name:GUILLERMO
Other - Last Name:DEL VALLE BALAGUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1907 JOSE SABATER
Mailing Address - Street 2:PASEO LOS ROBLES
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:787-805-7361
Mailing Address - Fax:787-831-6243
Practice Address - Street 1:CALLE DE DIEGO ESG PERAL
Practice Address - Street 2:CORDONNES LA PALMA SUITE IJ
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-6242
Practice Address - Fax:787-831-6243
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13173208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55674Medicare UPIN