Healthcare Provider Details

I. General information

NPI: 1255569844
Provider Name (Legal Business Name): JUDITH VALENCIA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9804 SW 40TH ST
MIAMI FL
33165-3912
US

IV. Provider business mailing address

9804 SW 40TH ST
MIAMI FL
33165-3912
US

V. Phone/Fax

Practice location:
  • Phone: 305-222-9154
  • Fax: 305-222-9155
Mailing address:
  • Phone: 305-222-9154
  • Fax: 305-222-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98844
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME98844
License Number StateFL

VIII. Authorized Official

Name: DR. JUDITH VALENCIA
Title or Position: PRESIDENT
Credential: MD
Phone: 305-222-9154