Healthcare Provider Details

I. General information

NPI: 1073730750
Provider Name (Legal Business Name): PALVAL MD'S PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIMA PLAZA 1 500 AVE. DEGETAU STE 415
CAGUAS PR
00725-7307
US

IV. Provider business mailing address

VENTANAS DE GURABO APTO. 263
GURABO PR
00778-5301
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-1415
  • Fax: 787-961-4662
Mailing address:
  • Phone: 787-743-1415
  • Fax: 787-961-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6879
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number6879
License Number StatePR

VIII. Authorized Official

Name: DR. MIGUEL A PALACIOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-743-1415