Provider Demographics
NPI:1245272384
Name:VALDES-VEGA, EDEL W (MD)
Entity type:Individual
Prefix:DR
First Name:EDEL
Middle Name:W
Last Name:VALDES-VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4051
Mailing Address - Country:US
Mailing Address - Phone:407-483-0672
Mailing Address - Fax:407-348-5882
Practice Address - Street 1:1412 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4051
Practice Address - Country:US
Practice Address - Phone:407-483-0672
Practice Address - Fax:407-348-5882
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12845208000000X
FLACN437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004787100Medicaid