Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003316308 |
---|---|
Provider Name | Elena Maria Valenzuela |
First Address | Key Largo, FL 33037-2437 |
Second Address | Key Largo, FL 33037-2437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2018 |
Last Update Date | 14/02/2018 |