Provider Demographics
NPI:1982615084
Name:VALLE MEDINA, ABEL (MD)
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:
Last Name:VALLE MEDINA
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 1:24 CALLE 2A
Mailing Address - Street 2:EXTENSION VILLA RICA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-236-1002
Mailing Address - Fax:
Practice Address - Street 1:24 CALLE 2A
Practice Address - Street 2:EXTENSION VILLA RICA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-236-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN716208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23602OtherTRIPLE S
PR123463OtherACAA
FLIM544ZMedicare PIN
PR23602OtherTRIPLE S