Healthcare Provider Details

I. General information

NPI: 1578069225
Provider Name (Legal Business Name): KELVIN DANIEL GARCED DEL VALLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 RED MAPLE CT
CHALFONT PA
18914-4413
US

IV. Provider business mailing address

216 RED MAPLE CT
CHALFONT PA
18914-4413
US

V. Phone/Fax

Practice location:
  • Phone: 787-361-2227
  • Fax:
Mailing address:
  • Phone: 787-361-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1578069225
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21680
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: