Provider Demographics
NPI:1134144710
Name:PALMS WEST OB-GYN ASSOCIATES PA
Entity Type:Organization
Organization Name:PALMS WEST OB-GYN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:VALDESCRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-795-2400
Mailing Address - Street 1:12953 PALMS WEST DR
Mailing Address - Street 2:SUITE 101 BLDG 6
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4990
Mailing Address - Country:US
Mailing Address - Phone:561-795-2400
Mailing Address - Fax:561-795-6813
Practice Address - Street 1:12953 PALMS WEST DR
Practice Address - Street 2:SUITE 101 BLDG 6
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4990
Practice Address - Country:US
Practice Address - Phone:561-795-2400
Practice Address - Fax:561-795-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260434500Medicaid
FL260434500Medicaid