Provider Demographics
NPI:1932877891
Name:VALENCIA GOMEZ, IDANIA B
Entity Type:Individual
Prefix:
First Name:IDANIA
Middle Name:B
Last Name:VALENCIA GOMEZ
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 1:13365 SW 42ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3940
Mailing Address - Country:US
Mailing Address - Phone:786-797-8048
Mailing Address - Fax:
Practice Address - Street 1:13365 SW 42ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3940
Practice Address - Country:US
Practice Address - Phone:786-797-8048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician