Provider Demographics
NPI:1972023935
Name:VALDES, ANTHONY BRIAN
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BRIAN
Last Name: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 1:19800 SW 180TH AVE LOT 563
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-2620
Mailing Address - Country:US
Mailing Address - Phone:786-592-2263
Mailing Address - Fax:786-272-0440
Practice Address - Street 1:19800 SW 180TH AVE LOT 563
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-2620
Practice Address - Country:US
Practice Address - Phone:786-592-2263
Practice Address - Fax:786-272-0440
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician