Healthcare Provider Details

I. General information

NPI: 1871914176
Provider Name (Legal Business Name): GLORIA VALENCIA AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLORIA EYICEL DIAZ BARCO

II. Dates (important events)

Enumeration Date: 01/04/2014
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

V. Phone/Fax

Practice location:
  • Phone: 407-992-9229
  • Fax: 407-891-2911
Mailing address:
  • Phone: 407-992-9229
  • Fax: 407-891-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-01441
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberA-01441
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA-01441
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: