Provider Demographics
NPI:1649478389
Name:VALENCIA, JUDITH (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1740
Mailing Address - Country:US
Mailing Address - Phone:305-903-7142
Mailing Address - Fax:305-222-9155
Practice Address - Street 1:9804 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3912
Practice Address - Country:US
Practice Address - Phone:305-222-9154
Practice Address - Fax:305-222-9155
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98844208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279199400Medicaid
FLME98844OtherMEDICAL DOCTOR
FLBS492BMedicare PIN