Provider Demographics
NPI:1922998608
Name:PENALOZA RODRIGUEZ, VALENTINA ANDREA (EFDA)
Entity type:Individual
Prefix:
First Name:VALENTINA
Middle Name:ANDREA
Last Name:PENALOZA RODRIGUEZ
Suffix:
Gender:F
Credentials:EFDA
Other - Prefix:
Other - First Name:VALENTINA
Other - Middle Name:
Other - Last Name:PENALOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EFDA
Mailing Address - Street 1:3 S THACKER AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 S THACKER AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5958
Practice Address - Country:US
Practice Address - Phone:321-503-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5765126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant