Healthcare Provider Details

I. General information

NPI: 1659024040
Provider Name (Legal Business Name): CARLOS JAVIER VALIENTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N KENDALL DR STE 602E
MIAMI FL
33176-2177
US

IV. Provider business mailing address

PO BOX 100905
ATLANTA GA
30384-0905
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-8040
  • Fax: 786-533-9760
Mailing address:
  • Phone: 786-596-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: