Provider Demographics
NPI:1750197349
Name:VALDES AVILA, TONIEL
Entity type:Individual
Prefix:
First Name:TONIEL
Middle Name:
Last Name:VALDES AVILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19701 SW 110TH CT APT 631
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8472
Mailing Address - Country:US
Mailing Address - Phone:305-910-3010
Mailing Address - Fax:
Practice Address - Street 1:19701 SW 110TH CT APT 631
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8472
Practice Address - Country:US
Practice Address - Phone:305-910-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-390564106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician