Provider Demographics
NPI:1396880720
Name:VALENTIN, MIRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAN
Middle Name:
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1729
Mailing Address - Country:US
Mailing Address - Phone:787-854-1357
Mailing Address - Fax:787-854-1357
Practice Address - Street 1:FLAMBOYAN MARGINAL B10
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1357
Practice Address - Fax:787-854-1357
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12681208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12681OtherMEDICAL LICENSE