Healthcare Provider Details

I. General information

NPI: 1396880720
Provider Name (Legal Business Name): MIRIAN VALENTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLAMBOYAN MARGINAL B10
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1729
VEGA BAJA PR
00694-1729
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-1357
  • Fax: 787-854-1357
Mailing address:
  • Phone: 787-854-1357
  • Fax: 787-854-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12681
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier12681
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerMEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: