Healthcare Provider Details

I. General information

NPI: 1134030273
Provider Name (Legal Business Name): RENATO VALDIVIESO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3555
US

IV. Provider business mailing address

3940 MIDDLESEX PL
SARASOTA FL
34241-5929
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: