Provider Demographics
NPI:1225209141
Name:VALENCIAS MEDICAL CARE PA
Entity Type:Organization
Organization Name:VALENCIAS MEDICAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-993-0092
Mailing Address - Street 1:101 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33493-1829
Mailing Address - Country:US
Mailing Address - Phone:561-993-0092
Mailing Address - Fax:561-993-0488
Practice Address - Street 1:101 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BAY
Practice Address - State:FL
Practice Address - Zip Code:33493-1829
Practice Address - Country:US
Practice Address - Phone:561-993-0092
Practice Address - Fax:561-993-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51596AOtherMEDICARE P-TAN
FL258639800Medicaid
FLH34176Medicare UPIN