MEDICARE: HEIDY VALDIVIA

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508503327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDY VALDIVIA

Provider Business Mailing Address
First Line	:	7821 N CORTEZ ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2615
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4236 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625
Country	:	US
Telephone Number	:	813-557-1525
Fax Number	:

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

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	03/01/2025

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Directions to “ HEIDY VALDIVIA ” Practice Location

Language	Start Address	Practice Location

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