Healthcare Provider Details

I. General information

NPI: 1023126430
Provider Name (Legal Business Name): PEDRO F DEL VALLE DE TOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON SUITE 715 TORRE AUXILIO MUTUO
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 AVE PONCE DE LEON SUITE 715 TORRE AUXILIO MUTUO
SAN JUAN PR
00917-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-250-0125
  • Fax: 787-773-8008
Mailing address:
  • Phone: 787-250-0125
  • Fax: 787-773-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11593
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: