1730309915 NPI number — JOSE A VALLES MD

Table of content: JOSE A VALLES MD (NPI 1730309915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730309915 NPI number — JOSE A VALLES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALLES
Provider First Name:
JOSE
Provider Middle Name:
A
Provider Name Prefix Text:
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:
1730309915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO. BOX 974
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-0974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-744-4499
Provider Business Mailing Address Fax Number:
787-746-2454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. DEGETAU 500 TOVRE HIMA PLAZA
Provider Second Line Business Practice Location Address:
SUITE 503-504
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-744-4499
Provider Business Practice Location Address Fax Number:
787-746-2454
Provider Enumeration Date:
04/27/2007

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: 225B00000X , with the licence number:  10594 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 10594 , 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: 20385 . This is a "TRIPLE SS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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