Provider Demographics
NPI:1053646174
Name:VALENTINA BRADLEY MD, PA
Entity Type:Organization
Organization Name:VALENTINA BRADLEY MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-634-1595
Mailing Address - Street 1:6333 N FEDERAL HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1907
Mailing Address - Country:US
Mailing Address - Phone:954-634-1595
Mailing Address - Fax:954-634-1594
Practice Address - Street 1:6333 N FEDERAL HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1907
Practice Address - Country:US
Practice Address - Phone:954-634-1595
Practice Address - Fax:954-634-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94814261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH62180Medicare UPIN