1063598266 NPI number — DR. RAMON H BERMUDEZ-DEL VALLE MD

Table of content: DR. RAMON H BERMUDEZ-DEL VALLE MD (NPI 1063598266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063598266 NPI number — DR. RAMON H BERMUDEZ-DEL VALLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERMUDEZ-DEL VALLE
Provider First Name:
RAMON
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063598266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00970-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-789-3733
Provider Business Mailing Address Fax Number:
787-789-3733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE PONCE DE LEON PDA 371/2
Provider Second Line Business Practice Location Address:
HOSPITAL AUXILIO MUTUO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00919-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-447-0826
Provider Business Practice Location Address Fax Number:
787-789-3733
Provider Enumeration Date:
10/31/2006

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: 207RI0200X , with the licence number:  16253020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 2657 , 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)

  • Identifier: 66040 . This is a "MAPPRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 234020 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10391 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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