MEDICARE: MAYRA ALEJANDRA VALDES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant		FL

General Provider Information

NPI Number	:	1386418549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA ALEJANDRA VALDES

Provider Business Mailing Address
First Line	:	6155 NW 105TH CT APT 7129
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-6711
Country	:	US
Telephone Number	:	786-820-2027
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 NE 81ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-4519
Country	:	US
Telephone Number	:	305-456-2680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2023
Last Update Date	:	11/08/2023

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Directions to “ MAYRA ALEJANDRA VALDES ” Practice Location

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