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General NPI Number Information
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NPI Number | 1598026858
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Entity Type | Organization
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Legal Business Name | VALENCIA NEUROSPINA CENTER PA
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 729 COUNTY ROAD 466
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City | LADY LAKE
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State | FL
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Zip | 32159-6340
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Country | US
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Telephone | 352-633-1880
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Fax | 352-633-1882
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Provider Business Mailing Address
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Address Line | 729 COUNTY ROAD 466
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City | LADY LAKE
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State | FL
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Zip | 32159-6340
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Country | US
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Telephone | 352-633-1880
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Fax | 352-633-1882
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER VALENCIA
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Credential | MD
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Telephone | 352-633-1880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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