MEDICARE: DR. EDGARDO RODRIGUEZ VALLECILLO 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	207N00000X	Dermatology Physician	6941	PR

General Provider Information

NPI Number	:	1235197765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGARDO RODRIGUEZ VALLECILLO M.D.

Provider Business Mailing Address
First Line	:	29 CALLE WASHINGTON
Second Line	:	SUITE 507
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1521
Country	:	US
Telephone Number	:	787-723-7230
Fax Number	:	787-723-2723

Provider Business Practice Location Address
First Line	:	29 CALLE WASHINGTON
Second Line	:	SUITE 507
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1521
Country	:	US
Telephone Number	:	787-723-7230
Fax Number	:	787-723-2723

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/01/2015

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