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NPI Code Detail

MEDICARE: MR. RENFORD VALENTINE PTA

MEDICARE: MR. RENFORD VALENTINE PTA
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
1164W00000XLicensed Practical NursePN1071511FL
2174400000XSpecialistPTA18599FL

General Provider Information

NPI Number : 1407027840
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RENFORD VALENTINE PTA
Provider Business Mailing Address
First Line : 5803 NW 151ST ST
Second Line : #101
City : MIAMI LAKES
State : FL
Zip : 33014-2473
Country : US
Telephone Number : 305-231-5266
Fax Number : 305-231-5264
Provider Business Practice Location Address
First Line : 5803 NW 151ST ST
Second Line : #101
City : MIAMI LAKES
State : FL
Zip : 33014-2473
Country : US
Telephone Number : 305-231-5266
Fax Number : 305-231-5264
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2008
Last Update Date : 03/13/2008

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Directions to “ MR. RENFORD VALENTINE PTA” Practice Location

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