Provider Demographics
NPI:1043091895
Name:VALDES MARTINEZ, DINELLA ALICIA
Entity Type:Individual
Prefix:
First Name:DINELLA
Middle Name:ALICIA
Last Name:VALDES MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 FORESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2225
Mailing Address - Country:US
Mailing Address - Phone:813-327-2194
Mailing Address - Fax:
Practice Address - Street 1:7005 FORESTVIEW CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2225
Practice Address - Country:US
Practice Address - Phone:813-327-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician