Provider Demographics
NPI:1376330159
Name:DEL VALLE DOMINGUEZ, GRISSELLE YANIRA (MD)
Entity type:Individual
Prefix:
First Name:GRISSELLE
Middle Name:YANIRA
Last Name:DEL VALLE DOMINGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 3188
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9704
Mailing Address - Country:US
Mailing Address - Phone:787-235-4692
Mailing Address - Fax:
Practice Address - Street 1:306 CALLE 2
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5501
Practice Address - Country:US
Practice Address - Phone:787-474-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program