1366835282 NPI number — DR. MARCO A. DEL VALLE, OFICINA DENTAL CSP

Table of content: (NPI 1366835282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366835282 NPI number — DR. MARCO A. DEL VALLE, OFICINA DENTAL CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. MARCO A. DEL VALLE, OFICINA DENTAL CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1366835282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 835
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00602-0835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-868-7770
Provider Business Mailing Address Fax Number:
787-868-7770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 CALLE ESTACION
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-868-7770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DEL VALLE
Authorized Official First Name:
MARCO
Authorized Official Middle Name:
ANTONIO
Authorized Official Title or Position:
GENERAL DENTIS
Authorized Official Telephone Number:
787-868-7770

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  1828 , 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: 2073 . This is a "PUERTO RICO DEPARTMENT OF STATE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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