Provider Demographics
NPI:1306812243
Name:VALLEJO, NELSON (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:VALLEJO
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0008
Mailing Address - Country:US
Mailing Address - Phone:787-733-3508
Mailing Address - Fax:787-733-0925
Practice Address - Street 1:AVE JOSE C BARBOSA
Practice Address - Street 2:# 225
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-3508
Practice Address - Fax:787-733-0925
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF86962Medicare UPIN
PR83785Medicare ID - Type Unspecified