=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962293647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY VAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2025
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | A5 CALLE ANICETO DIAZ
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-339-5098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | A5 CALLE ANICETO DIAZ
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-339-5098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | DR. CARLOS R VALCARCEL MIRANDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-948-2822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------