Provider Demographics
NPI:1730207457
Name:VALENTIN, JORGE LUIS (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 AVE HOSTOS
Mailing Address - Street 2:MEDICAL EMPORIUM 308
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1502
Mailing Address - Country:US
Mailing Address - Phone:787-316-1479
Mailing Address - Fax:787-408-4844
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:MEDICAL EMPORIUM 308
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-316-1479
Practice Address - Fax:787-408-4844
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR93422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26-0273-3OtherACAA (STATE AUTO ACC INS
PR54-09342OtherUIA
PR127OtherHUMANA INS
PR14-9342OtherMCS
PR03862OtherAMERICAN HEALTH
PR127OtherHUMANA HEALTH
PR82573OtherTRIPLE S
PR5471OtherPREFFERED HEALTH MEDICARE
PR148110OtherVALUE OPTIONS
PR1934OtherMMM
PR222147OtherTRIPLE S MEDICARE OPTIONS
PR127OtherHUMANA HEALTH
PR14-9342OtherMCS