Healthcare Provider Details

I. General information

NPI: 1386418549
Provider Name (Legal Business Name): MAYRA ALEJANDRA VALDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 NE 81ST ST
MIAMI FL
33138-4519
US

IV. Provider business mailing address

6155 NW 105TH CT APT 7129
DORAL FL
33178-6711
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-2680
  • Fax:
Mailing address:
  • Phone: 786-820-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: