Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 4301093755 | MI |
Y | 207T00000X | Neurosurgeon | ME122350 | FL |
N | 207T00000X | Neurosurgeon | PG 76521 | AZ |
NPI | 1043413412 |
---|---|
Provider Name | Dr. Juan Martin Valdivia Valdivia |
First Address | Clearwater, FL 33757-8744 |
Second Address | Tampa, FL 33607-6383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 22/10/2015 |