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General NPI Number Information
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NPI Number | 1770771271
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Entity Type | Organization
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Legal Business Name | PINES ADVANCED MEDICAL GROUP, P.A.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 17901 NW 5TH ST SUITE 106
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2810
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Country | US
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Telephone | 954-704-2888
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Fax | 954-704-0227
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Provider Business Mailing Address
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Address Line | 17901 NW 5TH ST SUITE 106
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2810
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Country | US
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Telephone | 954-704-2888
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Fax | 954-704-0227
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | DR. GERARDO ALBERTO VALDES
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Credential | M.D.
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Telephone | 954-704-2888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME84420
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License Number State | FL
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