MEDICARE: VALENCIAS MEDICAL CARE PA

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	207R00000X	Internal Medicine Physician	OS8098	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51596A	OTHER	FL	MEDICARE P-TAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225209141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALENCIAS MEDICAL CARE PA

Provider Business Mailing Address
First Line	:	101 NW 1ST AVE
Second Line	:
City	:	SOUTH BAY
State	:	FL
Zip	:	33493-1829
Country	:	US
Telephone Number	:	561-993-0092
Fax Number	:	561-993-0488

Provider Business Practice Location Address
First Line	:	101 NW 1ST AVE
Second Line	:
City	:	SOUTH BAY
State	:	FL
Zip	:	33493-1829
Country	:	US
Telephone Number	:	561-993-0092
Fax Number	:	561-993-0488

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUCY VALENCIA
Credential	:	D.O.
Telephone Number	:	561-993-0092

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	08/07/2008

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Directions to “VALENCIAS MEDICAL CARE PA ” Practice Location

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