Provider Demographics
NPI:1376343905
Name:DUCTAN, VALENTINA (CRANIAL PROSTHESIS S)
Entity type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:DUCTAN
Suffix:
Gender:F
Credentials:CRANIAL PROSTHESIS S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S 2ND ST STE 21
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 S 2ND ST STE 21
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4148
Practice Address - Country:US
Practice Address - Phone:863-956-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier