Provider Demographics
NPI:1245697218
Name:ANDRE, VALENTIN JUNIOR (MD)
Entity type:Individual
Prefix:
First Name:VALENTIN
Middle Name:JUNIOR
Last Name:ANDRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW 85TH AVE
Mailing Address - Street 2:APT 108
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5416
Mailing Address - Country:US
Mailing Address - Phone:407-219-6087
Mailing Address - Fax:
Practice Address - Street 1:1272 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-3232
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-267-1817
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR019240208D00000X
FLACN 841208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018679000Medicaid
FL018679000Medicaid