Healthcare Provider Details

I. General information

NPI: 1053646174
Provider Name (Legal Business Name): VALENTINA BRADLEY MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 N FEDERAL HWY SUITE 110
FORT LAUDERDALE FL
33308-1907
US

IV. Provider business mailing address

6333 N FEDERAL HWY SUITE 110
FORT LAUDERDALE FL
33308-1907
US

V. Phone/Fax

Practice location:
  • Phone: 954-634-1595
  • Fax: 954-634-1594
Mailing address:
  • Phone: 954-634-1595
  • Fax: 954-634-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME 94814
License Number StateFL

VIII. Authorized Official

Name: DR. VALENTINA R BRADLEY
Title or Position: MD
Credential: MD
Phone: 954-634-1595