Healthcare Provider Details

I. General information

NPI: 1528092145
Provider Name (Legal Business Name): ANTONIO I DEL VALLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PEDIATRICS UNIVERSITY PEDIATRICS HOSPITAL, OFFICE 1 A 29
SAN JUAN PR
00936-5067
US

IV. Provider business mailing address

253 CALLE SIERRA MORENA SUITE 157
SAN JUAN PR
00926-5539
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-4020
  • Fax: 787-777-3227
Mailing address:
  • Phone: 787-756-4020
  • Fax: 787-777-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number12677
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: