Provider Demographics
NPI:1013730878
Name:PIMENTEL VALDES, OSMANY
Entity type:Individual
Prefix:
First Name:OSMANY
Middle Name:
Last Name:PIMENTEL 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 1:6070 W 19TH AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6058
Mailing Address - Country:US
Mailing Address - Phone:786-781-0179
Mailing Address - Fax:
Practice Address - Street 1:6070 W 19TH AVE APT 307
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6058
Practice Address - Country:US
Practice Address - Phone:786-781-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24377528106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician