Healthcare Provider Details

I. General information

NPI: 1235475435
Provider Name (Legal Business Name): MARIA A. VALDIVIA P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 SW 1ST ST STE 320
MIAMI FL
33135-2321
US

IV. Provider business mailing address

1393 SW 1ST ST STE 320
MIAMI FL
33135-2321
US

V. Phone/Fax

Practice location:
  • Phone: 305-644-0977
  • Fax: 305-644-0114
Mailing address:
  • Phone: 305-644-0977
  • Fax: 305-644-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA A VALDIVIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-644-0977