MEDICARE: MARIANNE DEL VALLE M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	5435	PR

General Provider Information

NPI Number	:	1790138709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE DEL VALLE M.A.

Provider Business Mailing Address
First Line	:	COND PLZ
Second Line	:	500 CAMINO LOS PIZARROS APT 56
City	:	SAN JUAN
State	:	PR
Zip	:	00907-4442
Country	:	US
Telephone Number	:	787-210-3604
Fax Number	:

Provider Business Practice Location Address
First Line	:	COND PLZ
Second Line	:	500 CAMINO LOS PIZARROS APT 56
City	:	SAN JUAN
State	:	PR
Zip	:	00907-4442
Country	:	US
Telephone Number	:	787-210-3604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	07/14/2016

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