Provider Demographics
NPI:1225802515
Name:VALDES MORALES, KELVIN ARMANDO
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:ARMANDO
Last Name:VALDES MORALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15690 BULL RUN RD APT 2821
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2192
Mailing Address - Country:US
Mailing Address - Phone:305-954-1220
Mailing Address - Fax:
Practice Address - Street 1:15690 BULL RUN RD APT 2821
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2192
Practice Address - Country:US
Practice Address - Phone:305-954-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-308053106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty