=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124897020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICENTE D VALENZUELA APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2023
-----------------------------------------------------
Last Update Date | 07/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7480 BIRD RD STE 560
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-6657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-707-5688
-----------------------------------------------------
Fax | 305-760-4149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 NW 14TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-2137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-243-4917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11030259
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------