Healthcare Provider Details

I. General information

NPI: 1730867086
Provider Name (Legal Business Name): SEBASTIAN MARCOS HERNANDEZ DEL VALLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSIDAD CARLOS ALBIZU, 151 CALLE DE LA TANCA
SAN JUAN PR
00901
US

IV. Provider business mailing address

URB. LAS LOMAS 21ST STREET SW 787
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: