Healthcare Provider Details

I. General information

NPI: 1053388462
Provider Name (Legal Business Name): ORLANDO VALLEJO-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 AVE HIPODROMO
SAN JUAN PR
00909-2516
US

IV. Provider business mailing address

HC 1 BOX 26911
CAGUAS PR
00725-8933
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-3734
  • Fax: 787-724-1322
Mailing address:
  • Phone: 787-724-3734
  • Fax: 787-724-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12635
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: