Healthcare Provider Details

I. General information

NPI: 1144133844
Provider Name (Legal Business Name): HAVEN HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CALLE FONT MARTELO
HUMACAO PR
00791-3357
US

IV. Provider business mailing address

PO BOX 8399
HUMACAO PR
00792-8399
US

V. Phone/Fax

Practice location:
  • Phone: 939-405-0943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MOISES M VALDEZ
Title or Position: PRESIDENTE
Credential: MD
Phone: 939-405-0943