MEDICARE: DR. PABLO DEL VALLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	11715	PR

General Provider Information

NPI Number	:	1063411247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PABLO DEL VALLE M.D.

Provider Business Mailing Address
First Line	:	CALLE FERROL #23
Second Line	:	CIUDAD JARDIN NORTE
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	787-743-5405
Fax Number	:	787-733-2640

Provider Business Practice Location Address
First Line	:	CALLE JESUS T. PINERO A-4
Second Line	:
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771
Country	:	US
Telephone Number	:	787-733-2640
Fax Number	:	787-733-2640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	12/01/2015

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