Provider Demographics
NPI:1427268846
Name:DEL VALLE, MIRIAM (MD)
Entity type:Individual
Prefix:MR
First Name:MIRIAM
Middle Name:
Last Name:DEL VALLE
Suffix:
Gender:F
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:D88 CALLE 5
Mailing Address - Street 2:VILLA PALMIRA
Mailing Address - City:PUNTA SANTIAGO
Mailing Address - State:PR
Mailing Address - Zip Code:00741-2019
Mailing Address - Country:US
Mailing Address - Phone:787-285-1117
Mailing Address - Fax:787-736-2105
Practice Address - Street 1:CALLE E URB. MONTE BRISAS
Practice Address - Street 2:SUITE 80
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-801-3071
Practice Address - Fax:787-801-3073
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8357208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40998Medicare UPIN