MEDICARE: VALENCIA EMERGENCY PHYSICIANS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1255902664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALENCIA EMERGENCY PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12530 US HIGHWAY 301 S
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-7651
Country	:	US
Telephone Number	:	973-251-1132
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	973-251-1132

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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