Provider Demographics
NPI:1770750705
Name:ATHENA L VALENCIA MD PA
Entity type:Organization
Organization Name:ATHENA L VALENCIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-973-8167
Mailing Address - Street 1:2726 WINDGUARD CIR
Mailing Address - Street 2:STE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7361
Mailing Address - Country:US
Mailing Address - Phone:813-973-8167
Mailing Address - Fax:813-991-7654
Practice Address - Street 1:8702 BAY LAUREL CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2280
Practice Address - Country:US
Practice Address - Phone:813-973-8167
Practice Address - Fax:813-991-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME66946OtherFLORIDA MEDICAL LICENSE