Provider Demographics
NPI:1215918651
Name:DELVALLE TORRES, ANGEL R (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:R
Last Name:DELVALLE TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGEL
Other - Middle Name:R
Other - Last Name:DEL VALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1330
Mailing Address - Country:US
Mailing Address - Phone:787-898-5019
Mailing Address - Fax:787-898-4924
Practice Address - Street 1:189 AVE DR SUSONI
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-898-5019
Practice Address - Fax:787-898-4924
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13923208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084337Medicare ID - Type UnspecifiedPROVIDER NUMBER