Provider Demographics
NPI:1871038208
Name:FERNANDEZ VALDES, RUDDY
Entity Type:Individual
Prefix:
First Name:RUDDY
Middle Name:
Last Name:FERNANDEZ VALDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17810 NW 14TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4180
Mailing Address - Country:US
Mailing Address - Phone:786-532-7862
Mailing Address - Fax:
Practice Address - Street 1:1660 SOUTHERN BLVD STE C
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-3219
Practice Address - Country:US
Practice Address - Phone:561-653-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCABA-0-19-9778106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst