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General NPI Number Information
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NPI Number | 1639211709
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Entity Type | Organization
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Legal Business Name | VALLEY PEDIATRICS
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CALLE FRANCISCO SUSTACHE ESQ BALDORIOTY # 35C
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City | YABUCOA
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State | PR
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Zip | 00767-0000
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Country | US
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Telephone | 787-850-1858
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Fax | 787-285-4060
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Provider Business Mailing Address
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Address Line | P O BOX 9092
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City | HUMACAO
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State | PR
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Zip | 00792-0000
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Country | US
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Telephone | 787-850-1858
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Fax | 787-285-4060
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Authorized Official
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Title or Position | PEDIATRA
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Name | DR. MARIA DEL R DE LEON
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Credential | MD
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Telephone | 787-266-2701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 11350
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License Number State | PR
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