Healthcare Provider Details

I. General information

NPI: 1689581118
Provider Name (Legal Business Name): JESSE VALIENTE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N DIXIE HWY
POMPANO BEACH FL
33060-5621
US

IV. Provider business mailing address

896 WATER TOWER WAY APT 414
HYPOLUXO FL
33462-6328
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-8285
  • Fax: 954-928-0040
Mailing address:
  • Phone: 561-670-0692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number9467746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: