Provider Demographics
NPI:1144862079
Name:VALDES, ERNESTO JOSE (AP)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:JOSE
Last Name:VALDES
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6732
Mailing Address - Country:US
Mailing Address - Phone:321-235-6230
Mailing Address - Fax:321-235-6246
Practice Address - Street 1:4227 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6732
Practice Address - Country:US
Practice Address - Phone:321-235-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty