Provider Demographics
NPI:1730217118
Name:JOSE M. VALDIVIA JR, M.D., P.A.
Entity type:Organization
Organization Name:JOSE M. VALDIVIA JR, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:VALDIVIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-534-8550
Mailing Address - Street 1:400 W 41ST ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3516
Mailing Address - Country:US
Mailing Address - Phone:305-534-8550
Mailing Address - Fax:305-534-3790
Practice Address - Street 1:400 W 41ST ST
Practice Address - Street 2:SUITE 406
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3516
Practice Address - Country:US
Practice Address - Phone:305-534-8550
Practice Address - Fax:305-534-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00471002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96824Medicare ID - Type Unspecified