Healthcare Provider Details

I. General information

NPI: 1063408946
Provider Name (Legal Business Name): MR. EDWIN VALENTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/18/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RD. #1 KM 49.0
CIDRA PR
00739-0073
US

IV. Provider business mailing address

HC 71 BOX 7619
CAYEY PR
00736-9575
US

V. Phone/Fax

Practice location:
  • Phone: 787-714-1111
  • Fax: 787-715-7332
Mailing address:
  • Phone: 407-765-6131
  • Fax: 787-715-7332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS38552
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS38552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: