MEDICARE: LUIS R VALENZUELA ANGUEINA MS

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	231H00000X	Audiologist	556	PR

General Provider Information

NPI Number	:	1699788299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS R VALENZUELA ANGUEINA MS

Provider Business Mailing Address
First Line	:	EDIF CADILLA 100 PASEO SAN PABLO
Second Line	:	SUITE 412
City	:	BAYAMON
State	:	PR
Zip	:	00961-7028
Country	:	US
Telephone Number	:	787-798-5000
Fax Number	:	787-798-5028

Provider Business Practice Location Address
First Line	:	EDIF CADILLA 100 HIMA SAN PABLO
Second Line	:	SUITE 412
City	:	BAYAMON
State	:	PR
Zip	:	00961-7028
Country	:	US
Telephone Number	:	787-798-5000
Fax Number	:	787-798-5028

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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