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NPI Code Detail

MEDICARE: MR. ANGEL GADIEL ORTEGA-VALENTIN LCSW

MEDICARE: MR. ANGEL GADIEL ORTEGA-VALENTIN LCSW
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
1104100000XSocial Worker
21041C0700XClinical Social WorkerSW16923FL

General Provider Information

NPI Number : 1669737102
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANGEL GADIEL ORTEGA-VALENTIN LCSW
Provider Business Mailing Address
First Line : 13110 ELK MOUNTAIN DR
Second Line :
City : RIVERVIEW
State : FL
Zip : 33579-7182
Country : US
Telephone Number : 813-349-7567
Fax Number : 813-671-1696
Provider Business Practice Location Address
First Line : 801 E BAKER ST
Second Line :
City : PLANT CITY
State : FL
Zip : 33563-3652
Country : US
Telephone Number : 813-653-6100
Fax Number : 813-938-6423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2012
Last Update Date : 06/11/2021

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