Provider Demographics
NPI:1063411247
Name:DEL VALLE, PABLO (MD)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:DEL VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE FERROL #23
Mailing Address - Street 2:CIUDAD JARDIN NORTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-743-5405
Mailing Address - Fax:787-733-2640
Practice Address - Street 1:CALLE JESUS T. PINERO A-4
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-2640
Practice Address - Fax:787-733-2640
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11715207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG-40975Medicare UPIN
PR008-7804Medicare PIN