Healthcare Provider Details

I. General information

NPI: 1184728404
Provider Name (Legal Business Name): ANA Y VALDIVIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPT. OF NUCLEAR MED. 1695-A EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

27 WEAVER ST
LARCHMONT NY
10538-3311
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8461
  • Fax:
Mailing address:
  • Phone: 718-405-8461
  • Fax: 718-824-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number210271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: