Healthcare Provider Details

I. General information

NPI: 1467095679
Provider Name (Legal Business Name): VALERIE RODRIGUEZ-VALDIVIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10980 SW 25TH ST
MIAMI FL
33165-2345
US

IV. Provider business mailing address

10980 SW 25TH ST
MIAMI FL
33165-2345
US

V. Phone/Fax

Practice location:
  • Phone: 305-746-1414
  • Fax:
Mailing address:
  • Phone: 305-746-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11004627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: