Provider Demographics
NPI:1275112476
Name:VALDIVIA, VANESSA ANGELIQUE (DO)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANGELIQUE
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-4422
Mailing Address - Country:US
Mailing Address - Phone:386-310-2160
Mailing Address - Fax:
Practice Address - Street 1:222 S PENINSULA DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4422
Practice Address - Country:US
Practice Address - Phone:386-310-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS22272207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine