Provider Demographics
NPI:1508175688
Name:VALDES, HUMBERTO (MA)
Entity type:Individual
Prefix:MR
First Name:HUMBERTO
Middle Name:
Last Name:VALDES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1507
Mailing Address - Country:US
Mailing Address - Phone:786-436-6926
Mailing Address - Fax:786-953-5347
Practice Address - Street 1:10810 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1507
Practice Address - Country:US
Practice Address - Phone:786-436-6926
Practice Address - Fax:786-953-5347
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56560111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation