Provider Demographics
NPI:1922141852
Name:FELIPE ANTONIO DEL VALLE MD PA
Entity Type:Organization
Organization Name:FELIPE ANTONIO DEL VALLE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-263-0527
Mailing Address - Street 1:2350 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1160
Mailing Address - Country:US
Mailing Address - Phone:786-263-0527
Mailing Address - Fax:786-263-0529
Practice Address - Street 1:2350 SW 84TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1160
Practice Address - Country:US
Practice Address - Phone:786-263-0527
Practice Address - Fax:786-263-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061432700Medicaid
FL07692Medicare ID - Type Unspecified
FL061432700Medicaid