Provider Demographics
NPI:1225422074
Name:BALDIVIESO, VALERIA CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:CRISTINA
Last Name:BALDIVIESO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:CRISTINA
Other - Last Name:BALDIVIESO HURTADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1573 W FAIRBANKS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4679
Mailing Address - Country:US
Mailing Address - Phone:407-303-6729
Mailing Address - Fax:407-628-2037
Practice Address - Street 1:1573 W FAIRBANKS AVE STE 210
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4679
Practice Address - Country:US
Practice Address - Phone:407-303-6729
Practice Address - Fax:407-628-2037
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134252207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine