Healthcare Provider Details

I. General information

NPI: 1073942629
Provider Name (Legal Business Name): ANA MARIA MEJIA VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 NW 53RD ST
MIAMI FL
33166-4653
US

IV. Provider business mailing address

3930 SW 186TH TER
MIRAMAR FL
33029-2704
US

V. Phone/Fax

Practice location:
  • Phone: 305-748-4999
  • Fax:
Mailing address:
  • Phone: 786-318-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21518
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDRP1222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: