Provider Demographics
NPI:1609058387
Name:VALENTIN, DIMAS JOSE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DIMAS
Middle Name:JOSE
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-5119
Practice Address - Fax:321-434-1775
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103371363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT11174OtherFL OTR/L LICENCE NUMBER
FL015905500Medicaid
FLPA9103371OtherFL PA LICENCE NUMBER
FLOT11174OtherFL OTR/L LICENCE NUMBER
PAOC009699OtherPA OT LICENCE NUMBER
PAOC009699OtherPA OT LICENCE NUMBER