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General NPI Number Information
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NPI Number | 1033800453
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Entity Type | Individual
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Provider Name | JESENIA VALDES OWNER
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Gender | Female
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 4455 HENDRY ISLES BLVD
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City | CLEWISTON
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State | FL
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Zip | 33440-9633
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Country | US
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Telephone | 305-497-2473
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Fax |
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Provider Business Mailing Address
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Address Line | 4455 HENDRY ISLES BLVD
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City | CLEWISTON
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State | FL
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Zip | 33440-9633
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Country | US
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Telephone | 305-497-2473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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