Provider Demographics
NPI:1871881839
Name:VALDES, JUAN CARLOS
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:VALDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12595 SW 137TH AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4220
Mailing Address - Country:US
Mailing Address - Phone:786-581-9064
Mailing Address - Fax:786-581-9172
Practice Address - Street 1:12595 SW 137TH AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4220
Practice Address - Country:US
Practice Address - Phone:786-581-9064
Practice Address - Fax:786-581-9172
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57884261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation