MEDICARE: DR. CHARMAINE MARIE PEREZ-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	207R00000X	Internal Medicine Physician	14648	PR

General Provider Information

NPI Number	:	1144201179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARMAINE MARIE PEREZ-DEL VALLE M.D.

Provider Business Mailing Address
First Line	:	754 VALLE DEL TOA
Second Line	:	LOS CAMPOS DE MONTEHIEDRA
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7032
Country	:	US
Telephone Number	:	787-708-1761
Fax Number	:	787-641-4561

Provider Business Practice Location Address
First Line	:	754 VALLE DEL TOA
Second Line	:	LOS CAMPOS DE MONTEHIEDRA
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7032
Country	:	US
Telephone Number	:	787-708-1761
Fax Number	:	787-641-4561

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	01/24/2014

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