Provider Demographics
NPI:1124016654
Name:VALDES, JACQUELINE (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:VALDES
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 SW 117TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4803
Mailing Address - Country:US
Mailing Address - Phone:305-273-7950
Mailing Address - Fax:305-273-7954
Practice Address - Street 1:8000 SW 117TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4803
Practice Address - Country:US
Practice Address - Phone:305-273-7950
Practice Address - Fax:305-273-7954
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P 73024Medicare UPIN