Provider Demographics
NPI:1235771288
Name:VALDES, JOSE GABRIEL (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:GABRIEL
Last Name:VALDES
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8821 W FLAGLER ST APT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2423
Mailing Address - Country:US
Mailing Address - Phone:786-208-0065
Mailing Address - Fax:
Practice Address - Street 1:8821 W FLAGLER ST APT 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2423
Practice Address - Country:US
Practice Address - Phone:786-208-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9512079163WM0705X
FLAPRN11015471363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical