Healthcare Provider Details

I. General information

NPI: 1841855152
Provider Name (Legal Business Name): MARIA MERCEDES DE JESUS VALDES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

3663 S MIAMI AVE
MIAMI FL
33133-4237
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-4400
  • Fax:
Mailing address:
  • Phone: 305-854-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHSE150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: