Provider Demographics
NPI:1235703166
Name:ROBERTS, VALENCIA CHAVALA
Entity Type:Individual
Prefix:MRS
First Name:VALENCIA
Middle Name:CHAVALA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 CAPE COD CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4382
Mailing Address - Country:US
Mailing Address - Phone:813-724-7460
Mailing Address - Fax:813-324-9820
Practice Address - Street 1:746 CAPE COD CIR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-4382
Practice Address - Country:US
Practice Address - Phone:813-724-7460
Practice Address - Fax:813-324-9820
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237588376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty