Healthcare Provider Details

I. General information

NPI: 1902419807
Provider Name (Legal Business Name): EVA MIRANDA VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 W PERIMETER RD
JB ANDREWS MD
20762-6602
US

IV. Provider business mailing address

2455 MANDEVILLE LN APT 640
ALEXANDRIA VA
22314-6129
US

V. Phone/Fax

Practice location:
  • Phone: 240-857-7186
  • Fax:
Mailing address:
  • Phone: 727-265-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: