Provider Demographics
NPI:1912307190
Name:JOSE VALERIO MD PA
Entity Type:Organization
Organization Name:JOSE VALERIO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:VALERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-825-3746
Mailing Address - Street 1:9300 SW 87TH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2413
Mailing Address - Country:US
Mailing Address - Phone:305-405-8788
Mailing Address - Fax:786-363-1179
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE 616
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:844-825-3746
Practice Address - Fax:954-337-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108682174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1619148293OtherNPI
FLEF174ZMedicare UPIN