=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063598266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMON H BERMUDEZ-DEL VALLE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 03/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE PONCE DE LEON PDA 371/2 HOSPITAL AUXILIO MUTUO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00919-1227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-447-0826
-----------------------------------------------------
Fax | 787-789-3733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1737
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00970-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-789-3733
-----------------------------------------------------
Fax | 787-789-3733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 16253020
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 2657
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------