Provider Demographics
NPI:1396708947
Name:RODRIGUEZ DEL VALLE, JUAN (MD)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:RODRIGUEZ 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:P O BOX 361798
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1798
Mailing Address - Country:US
Mailing Address - Phone:787-294-0812
Mailing Address - Fax:787-294-1334
Practice Address - Street 1:52 CALLE MAYAGUEZ
Practice Address - Street 2:URBANIZACION PEREZ MORRIS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4915
Practice Address - Country:US
Practice Address - Phone:787-764-0473
Practice Address - Fax:787-764-0482
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0093138Medicare ID - Type Unspecified
PRE20112Medicare UPIN