Provider Demographics
NPI:1255592580
Name:VALDES, AURELIO (MD)
Entity type:Individual
Prefix:DR
First Name:AURELIO
Middle Name:
Last Name:VALDES
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 1:390 BALBOA DR
Mailing Address - Street 2:
Mailing Address - City:POINCIANA
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3600
Mailing Address - Country:US
Mailing Address - Phone:407-625-6667
Mailing Address - Fax:
Practice Address - Street 1:390 BALBOA DR
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-3600
Practice Address - Country:US
Practice Address - Phone:407-625-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AV448991Medicare UPIN
C08773Medicare PIN