Provider Demographics
NPI:1780126896
Name:VALDES, ISMARY
Entity type:Individual
Prefix:
First Name:ISMARY
Middle Name:
Last Name:VALDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 NW 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2914
Mailing Address - Country:US
Mailing Address - Phone:954-274-3590
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 154TH ST STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5861
Practice Address - Country:US
Practice Address - Phone:786-477-5783
Practice Address - Fax:305-512-8805
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15553224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant