Provider Demographics
NPI:1275130551
Name:VALDEZ QUINONEZ, EDGAR RAFAEL
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:RAFAEL
Last Name:VALDEZ QUINONEZ
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 1:634 DELTONA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8112
Mailing Address - Country:US
Mailing Address - Phone:407-878-7990
Mailing Address - Fax:407-732-7631
Practice Address - Street 1:634 DELTONA BLVD STE A
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8112
Practice Address - Country:US
Practice Address - Phone:407-878-7990
Practice Address - Fax:407-732-7631
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009595363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology