Provider Demographics
NPI:1700068459
Name:VALDES LUGONES, PEDRO P (PA)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:P
Last Name:VALDES LUGONES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5190 NW 167TH ST
Mailing Address - Street 2:STE 109
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6328
Mailing Address - Country:US
Mailing Address - Phone:305-620-4929
Mailing Address - Fax:305-620-4954
Practice Address - Street 1:5190 NW 167TH ST
Practice Address - Street 2:STE 109
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6328
Practice Address - Country:US
Practice Address - Phone:305-620-4929
Practice Address - Fax:305-620-4954
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9000008363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS68132Medicare UPIN
FLE1666AMedicare PIN