Healthcare Provider Details

I. General information

NPI: 1760397301
Provider Name (Legal Business Name): VALHALLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB LOS CAOBOS 2209 CALLE MAGA
PONCE PR
00716
US

IV. Provider business mailing address

B3 REPARTO MENDOZA
HUMACAO PR
00792-0216
US

V. Phone/Fax

Practice location:
  • Phone: 787-433-1994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE A VAZQUEZ GARCIA
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-433-1994