Provider Demographics
NPI:1457339541
Name:DIAZ DEL VALLE, EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:DIAZ DEL VALLE
Suffix:
Gender:M
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 8398
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8398
Mailing Address - Country:US
Mailing Address - Phone:787-743-6177
Mailing Address - Fax:787-744-9787
Practice Address - Street 1:CONSOLIDATED MALL C 4
Practice Address - Street 2:AVENIDA GAUTIER BENITEZ
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-9787
Practice Address - Fax:787-744-9787
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR826097OtherMEDICARE Y MUCHO MAS
PR68595OtherLA CRUZ AZUL
PR98601OtherMEDICARE OPTIMA
PR212171OtherPREFERED HEALTH
PR8667OtherFIRST MEDICAL
PR98601OtherTRIPLE S
0098601Medicare UPIN
PR68595OtherLA CRUZ AZUL
PR826097OtherMEDICARE Y MUCHO MAS