Provider Demographics
NPI:1619148293
Name:VALERIO, JOSE EDGARDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:EDGARDO
Last Name:VALERIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:EDGARDO
Other - Last Name:VALERIO-PASCUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 565338
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-5338
Mailing Address - Country:US
Mailing Address - Phone:305-218-4128
Mailing Address - Fax:786-363-1179
Practice Address - Street 1:6129 SW 70TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3451
Practice Address - Country:US
Practice Address - Phone:786-871-6800
Practice Address - Fax:786-871-6801
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108682207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003012400Medicaid