Healthcare Provider Details

I. General information

NPI: 1598596231
Provider Name (Legal Business Name): MICHEL VALDES CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

855 CENTRAL AVE UNIT 907
SAINT PETERSBURG FL
33701-3678
US

V. Phone/Fax

Practice location:
  • Phone: 727-462-7000
  • Fax:
Mailing address:
  • Phone: 305-896-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberNPO1
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: