Provider Demographics
NPI:1750918199
Name:TALAVERA VALENTIN, JAILEEN (MD)
Entity type:Individual
Prefix:MS
First Name:JAILEEN
Middle Name:
Last Name:TALAVERA VALENTIN
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 04 BOX 48700
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-8901
Mailing Address - Country:US
Mailing Address - Phone:787-402-5408
Mailing Address - Fax:787-881-9402
Practice Address - Street 1:HC 04 # 48700
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-8901
Practice Address - Country:US
Practice Address - Phone:787-402-5408
Practice Address - Fax:787-881-9402
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21688208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice