=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679966097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DV HEALTHCARE SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2015
-----------------------------------------------------
Last Update Date | 03/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1280 W 46TH ST UNIT 107
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-490-8817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1280 W 46TH ST UNIT 107
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-490-8817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAMARIS VALDES
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 305-490-8817
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9293928
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------