Healthcare Provider Details

I. General information

NPI: 1801475058
Provider Name (Legal Business Name): ALFREDO VALDIVIA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 HARBOUR VIEW BLVD
SUFFOLK VA
23435-3315
US

IV. Provider business mailing address

353 SUMMER ST UNIT 306
SOMERVILLE MA
02144-3154
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-5800
  • Fax:
Mailing address:
  • Phone: 305-332-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number289091
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101285292
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: