Provider Demographics
NPI:1609039031
Name:VALINA, JOAN GRACE B (MD)
Entity type:Individual
Prefix:
First Name:JOAN GRACE
Middle Name:B
Last Name:VALINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN GRACE
Other - Middle Name:VALINA
Other - Last Name:LINIEWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:747 PONCE DE LEON BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2073
Mailing Address - Country:US
Mailing Address - Phone:786-885-3305
Mailing Address - Fax:
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 403
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2073
Practice Address - Country:US
Practice Address - Phone:786-885-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459182208600000X
IL125058921208600000X
IN01073572A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032417260002Medicaid
IN201216770Medicaid
PA557961PNLMedicare PIN
940970015Medicare PIN