Provider Demographics
NPI:1568915494
Name:GOMEZ VALDES, MARLEN ALINA
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:ALINA
Last Name:GOMEZ VALDES
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 1:13243 SW 283RD TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7374
Mailing Address - Country:US
Mailing Address - Phone:786-308-7865
Mailing Address - Fax:
Practice Address - Street 1:13243 SW 283RD TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7374
Practice Address - Country:US
Practice Address - Phone:786-308-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician