1326010448 NPI number — MR. EDWIN ALBERTO DEL VALEE SEPULVEDA DMD

Table of content: MR. EDWIN ALBERTO DEL VALEE SEPULVEDA DMD (NPI 1326010448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326010448 NPI number — MR. EDWIN ALBERTO DEL VALEE SEPULVEDA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEL VALEE SEPULVEDA
Provider First Name:
EDWIN
Provider Middle Name:
ALBERTO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEL VALLE SEPULVEDA
Provider Other First Name:
EDWIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326010448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
F 5 LA CASA BLANCA ST
Provider Second Line Business Mailing Address:
PASEO SAN JUAN
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-286-9025
Provider Business Mailing Address Fax Number:
787-743-2985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 PONCE BY PASS
Provider Second Line Business Practice Location Address:
SUITE 605 PARNA MEDICAL INSTITUTE
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-841-7892
Provider Business Practice Location Address Fax Number:
787-259-7514
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  1553 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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