Healthcare Provider Details

I. General information

NPI: 1831224872
Provider Name (Legal Business Name): SOUTH BAY NEUROLOGY AND TOTAL SPINE CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 UPPER CREEK DR SUITE 111
SUN CITY CENTER FL
33573-6825
US

IV. Provider business mailing address

4051 UPPER CREEK DR SUITE 111
SUN CITY CENTER FL
33573-6825
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-3323
  • Fax: 813-634-4764
Mailing address:
  • Phone: 813-634-3323
  • Fax: 813-634-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER LINTAO VALENCIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 813-634-3323