Provider Demographics
NPI:1366032245
Name:VAL-DAS PREVENTIVE CARE CLINIC LLC
Entity Type:Organization
Organization Name:VAL-DAS PREVENTIVE CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUERDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALERE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-514-7422
Mailing Address - Street 1:6835 SUNSET STRIP
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2864
Mailing Address - Country:US
Mailing Address - Phone:954-514-7422
Mailing Address - Fax:
Practice Address - Street 1:6835 SUNSET STRIP
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2864
Practice Address - Country:US
Practice Address - Phone:954-514-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC15083OtherCERTIFICATE OF EXEMPTION HEALTH CARE CLINIC LICENSURE - AHCA