Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 12243 | PR |
NPI | 1285684217 |
---|---|
Provider Name | Dr. Jose Wilfredo Valle-Oliveras |
First Address | Naguabo, PR 00718-0548 |
Second Address | Naguabo, PR 00718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G61344 | (02) | PR |