Healthcare Provider Details

I. General information

NPI: 1407710742
Provider Name (Legal Business Name): BRYAN DEL VALLE-SANTOS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HILLCREST VILLAGE PUESTA DEL SOL
PONCE PR
00716
US

IV. Provider business mailing address

HILLCREST VILLAGE PUESTA DEL SOL
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 939-397-0627
  • Fax:
Mailing address:
  • Phone: 939-397-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7940
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: