MEDICARE: ANA DEL VALLE - FERNANDEZ PA

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	363A00000X	Physician Assistant	PA9112713	FL

General Provider Information

NPI Number	:	1437799731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA DEL VALLE - FERNANDEZ PA

Provider Business Mailing Address
First Line	:	11055 SW 25TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2348
Country	:	US
Telephone Number	:	786-282-8196
Fax Number	:

Provider Business Practice Location Address
First Line	:	9300 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3205
Country	:	US
Telephone Number	:	786-282-8196
Fax Number	:

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

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	01/14/2020

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