Healthcare Provider Details

I. General information

NPI: 1508131301
Provider Name (Legal Business Name): VALENTYN TYULMENKOV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 DEL PRADO CIR S
BOCA RATON FL
33433-3386
US

IV. Provider business mailing address

263 NW 70TH ST
BOCA RATON FL
33487-2392
US

V. Phone/Fax

Practice location:
  • Phone: 561-392-3000
  • Fax:
Mailing address:
  • Phone: 561-302-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME111260
License Number StateFL

VIII. Authorized Official

Name: DR. VALENTYN TYULMENKOV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-302-9515