Individual provider Active NPI

Marcos L Del Valle, DMD MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Ponce, PR
National Provider Identifier
1174511877
Registry record updated Jan 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
1554 Issued in PR
Practice address
2225 Ponce Byp
Ste 605
Ponce, PR 00717-1321
Phone
(787) 841-7892
Fax
(787) 259-7514
NPI assigned
Oct 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 1554 PR Primary

Addresses

Primary practice location

2225 Ponce Byp
Ste 605
Ponce, PR 00717-1321

Mailing address

2225 Ponce Byp
Ste 605
Ponce, PR 00717-1321
Phone (787) 841-7892

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160205000949 PR Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7618271065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1554PRMDOral and Maxillofacial Surgery (Dentist)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201219200000",
    "number": "1174511877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 PONCE BYP",
            "address_2": "STE 605",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007171321",
            "telephone_number": "787-841-7892",
            "fax_number": "787-259-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 PONCE BYP",
            "address_2": "STE 605",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007171321",
            "telephone_number": "787-841-7892",
            "fax_number": "787-259-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEL VALLE",
        "first_name": "MARCOS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2008-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PR",
            "license": "1554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

Verify at the official NPI Registry.