Healthcare Provider Details

I. General information

NPI: 1548189897
Provider Name (Legal Business Name): VICTOR VALDIVIA EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 2ND ST
FRANKFORT KY
40601-2652
US

IV. Provider business mailing address

208 DOVE PARK
VERSAILLES KY
40383-1504
US

V. Phone/Fax

Practice location:
  • Phone: 859-753-3030
  • Fax:
Mailing address:
  • Phone: 859-753-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number1121642
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: