Healthcare Provider Details

I. General information

NPI: 1164419875
Provider Name (Legal Business Name): MARLENE VALENTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 W WATERS AVE
TAMPA FL
33614-1852
US

IV. Provider business mailing address

2809 W WATERS AVE
TAMPA FL
33614-1852
US

V. Phone/Fax

Practice location:
  • Phone: 813-348-9088
  • Fax: 813-348-9310
Mailing address:
  • Phone: 813-348-9088
  • Fax: 813-348-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME92818
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME92818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: