Healthcare Provider Details

I. General information

NPI: 1639211709
Provider Name (Legal Business Name): VALLEY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FRANCISCO SUSTACHE ESQ BALDORIOTY # 35C
YABUCOA PR
00767-0000
US

IV. Provider business mailing address

P O BOX 9092
HUMACAO PR
00792-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-850-1858
  • Fax: 787-285-4060
Mailing address:
  • Phone: 787-850-1858
  • Fax: 787-285-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number11350
License Number StatePR

VIII. Authorized Official

Name: DR. MARIA DEL R DE LEON
Title or Position: PEDIATRA
Credential: MD
Phone: 787-266-2701