MEDICARE: RAIDEL VALDES-CRESPO MD

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	207R00000X	Internal Medicine Physician	ME119106	FL

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	:	1770829574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAIDEL VALDES-CRESPO MD

Provider Business Mailing Address
First Line	:	4730 N HABANA AVE STE 204
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7148
Country	:	US
Telephone Number	:	786-715-8147
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 N HABANA AVE STE 204
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7148
Country	:	US
Telephone Number	:	786-715-8147
Fax Number	:

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

Provider Enumeration Date	:	12/25/2012
Last Update Date	:	01/04/2021

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