Provider Demographics
NPI:1497488266
Name:VALDIVIA, EVERT
Entity Type:Individual
Prefix:
First Name:EVERT
Middle Name:
Last Name:VALDIVIA
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 1:7200 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5348
Mailing Address - Country:US
Mailing Address - Phone:786-608-9125
Mailing Address - Fax:
Practice Address - Street 1:2300 W 84TH ST STE 104
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5771
Practice Address - Country:US
Practice Address - Phone:305-903-3168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician