Provider Demographics
NPI:1780620260
Name:VALIENTE, QUINTIN A
Entity type:Individual
Prefix:MR
First Name:QUINTIN
Middle Name:A
Last Name:VALIENTE
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 1:3901 NW 79TH AVE STE 241
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6506
Mailing Address - Country:US
Mailing Address - Phone:786-286-9594
Mailing Address - Fax:305-594-2881
Practice Address - Street 1:7775 NW 48TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5468
Practice Address - Country:US
Practice Address - Phone:305-594-2881
Practice Address - Fax:305-594-2871
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FL430802471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography