Healthcare Provider Details

I. General information

NPI: 1104232230
Provider Name (Legal Business Name): GRACE MARIA VALENZUELA BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST RM 1213
MIAMI FL
33136
US

IV. Provider business mailing address

10331 SW 55TH ST
MIAMI FL
33165-7012
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5600
  • Fax:
Mailing address:
  • Phone: 305-965-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: