Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 11715 | PR |
NPI | 1063411247 |
---|---|
Provider Name | Dr. Pablo Del Valle |
First Address | Caguas, PR 00725 |
Second Address | Las Piedras, PR 00771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 01/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G-40975 | (02) | PR |