Provider Demographics
NPI:1629366331
Name:VALDEZ-BERTOLINO, MARITZA M (MD)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:M
Last Name:VALDEZ-BERTOLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARITZA
Other - Middle Name:MARJORIE
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-493-6496
Mailing Address - Fax:954-493-6726
Practice Address - Street 1:6181 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2227
Practice Address - Country:US
Practice Address - Phone:954-493-6496
Practice Address - Fax:954-493-6726
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109897208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003950400Medicaid