Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME62486 | FL |
N | 2080N0001X | Neonatal-Perinatal Doctor | ME62486 | FL |
NPI | 1124004932 |
---|---|
Provider Name | Dr. Pablo Antonio Valencia |
First Address | Plantation, FL 33318-7540 |
Second Address | Miami, FL 33155-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G12496 | (02) |