Provider Demographics
NPI:1659024040
Name:VALIENTE, CARLOS JAVIER (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAVIER
Last Name:VALIENTE
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:PO BOX 100905
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0905
Mailing Address - Country:US
Mailing Address - Phone:786-596-8040
Mailing Address - Fax:
Practice Address - Street 1:8940 N KENDALL DR STE 602E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2177
Practice Address - Country:US
Practice Address - Phone:786-596-8040
Practice Address - Fax:786-533-9760
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115645363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty