Healthcare Provider Details

I. General information

NPI: 1396708947
Provider Name (Legal Business Name): JUAN RODRIGUEZ DEL VALLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CALLE MAYAGUEZ URBANIZACION PEREZ MORRIS
SAN JUAN PR
00917-4915
US

IV. Provider business mailing address

P O BOX 361798
SAN JUAN PR
00936-1798
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-0473
  • Fax: 787-764-0482
Mailing address:
  • Phone: 787-294-0812
  • Fax: 787-294-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2497
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: