Healthcare Provider Details

I. General information

NPI: 1093255606
Provider Name (Legal Business Name): INGRID VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 107TH AVE SUITE #200
DORAL FL
33172-5925
US

IV. Provider business mailing address

1140 W 50TH ST
HIALEAH FL
33012-3440
US

V. Phone/Fax

Practice location:
  • Phone: 305-597-3861
  • Fax: 305-597-3863
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: