Provider Demographics
NPI:1336997634
Name:VALENCIA, MARIVIC
Entity Type:Individual
Prefix:MS
First Name:MARIVIC
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 HAWKSBILL LN
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-3159
Mailing Address - Country:US
Mailing Address - Phone:608-520-8835
Mailing Address - Fax:
Practice Address - Street 1:1129 HAWKSBILL LN
Practice Address - Street 2:
Practice Address - City:SUGARLOAF KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-3159
Practice Address - Country:US
Practice Address - Phone:608-520-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator