MEDICARE: TATIANA VALENCIA PSY.D

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	103T00000X	Psychologist	PY10429	FL

General Provider Information

NPI Number	:	1639732738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA VALENCIA PSY.D

Provider Business Mailing Address
First Line	:	1848 SE 1ST AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2875
Country	:	US
Telephone Number	:	954-885-9500
Fax Number	:	954-885-9444

Provider Business Practice Location Address
First Line	:	3191 CORAL WAY STE 623
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3230
Country	:	US
Telephone Number	:	786-344-2849
Fax Number	:

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

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	04/23/2020

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