Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 11711 | PR |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 11711 | PR |
NPI | 1407820657 |
---|---|
Provider Name | Luis E Valledor Maeso SR. |
First Address | San Juan, PR 00926 |
Second Address | Bayamon, PR 00960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 14/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G41773 | (02) | PR |