Healthcare Provider Details

I. General information

NPI: 1124100433
Provider Name (Legal Business Name): MRS. SYLVIA E. VALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 CRUCE DAVILA
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 2045
BARCELONETA PR
00617-2045
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-4412
  • Fax: 787-846-7410
Mailing address:
  • Phone: 787-846-4412
  • Fax: 787-846-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number01756
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: