Provider Demographics
NPI:1770829574
Name:VALDES-CRESPO, RAIDEL (MD)
Entity Type:Individual
Prefix:
First Name:RAIDEL
Middle Name:
Last Name:VALDES-CRESPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 N HABANA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7148
Mailing Address - Country:US
Mailing Address - Phone:786-715-8147
Mailing Address - Fax:
Practice Address - Street 1:4730 N HABANA AVE STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7148
Practice Address - Country:US
Practice Address - Phone:786-715-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-25
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119106207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012343800Medicaid