Healthcare Provider Details

I. General information

NPI: 1134739170
Provider Name (Legal Business Name): FIDEL VALLE YARANDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SW 133RD AVE
MIRAMAR FL
33027-5517
US

IV. Provider business mailing address

5000 SW 133RD AVE
MIRAMAR FL
33027-5517
US

V. Phone/Fax

Practice location:
  • Phone: 305-645-6256
  • Fax:
Mailing address:
  • Phone: 305-645-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-70309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: