Healthcare Provider Details

I. General information

NPI: 1437779618
Provider Name (Legal Business Name): EDUARDO CARLOS DEL VALLE PSYCHOLOGIST, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 UPSHUR ST NW
WASHINGTON DC
20011-5635
US

IV. Provider business mailing address

1350 UPSHUR ST NW
WASHINGTON DC
20011-5635
US

V. Phone/Fax

Practice location:
  • Phone: 202-671-6270
  • Fax:
Mailing address:
  • Phone: 202-671-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: