Provider Demographics
NPI:1063462844
Name:VALENCIA, MARIA LUZ BERNABE (RPT)
Entity type:Individual
Prefix:MS
First Name:MARIA LUZ
Middle Name:BERNABE
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BROKEN SOUND PKWY NW
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3507
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-658-3992
Practice Address - Street 1:15127 JOG RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1251
Practice Address - Country:US
Practice Address - Phone:561-495-6300
Practice Address - Fax:561-495-8877
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBOARD OF PHY THEROtherCERTIFICATION
CPR/AEDOtherAMERIAN HEART ASSOCIATION