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General NPI Number Information
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NPI Number | 1154550473
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Entity Type | Organization
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Legal Business Name | VICTORIA VALDESUSO PA
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 101 N OCEAN DR SUITE # 212
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City | HOLLYWOOD
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State | FL
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Zip | 33019-1728
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Country | US
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Telephone | 786-263-3854
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Fax |
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Provider Business Mailing Address
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Address Line | 932 EUCLID AVE APT #10
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City | MIAMI BEACH
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State | FL
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Zip | 33139-0821
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Country | US
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Telephone | 786-263-3854
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTORIA M VALDESUSO
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Credential | PSYD, ARNP
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Telephone | 786-263-3854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PY6404
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License Number State | FL
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