Provider Demographics
NPI:1962421545
Name:PENA VALDIVIA, RAUL F (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:F
Last Name:PENA VALDIVIA
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 2012
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2012
Mailing Address - Country:US
Mailing Address - Phone:787-621-6578
Mailing Address - Fax:
Practice Address - Street 1:A6 MARGINAL
Practice Address - Street 2:URB SAN SALVADOR
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-6578
Practice Address - Fax:787-621-6578
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16486207V00000X, 207VC0200X, 207VE0102X, 207VG0400X, 207VM0101X, 207VX0000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Not Answered207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Not Answered207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology