Provider Demographics
NPI:1063631240
Name:VALENCIA, ATHENA LARDIZABAL (MD)
Entity type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:LARDIZABAL
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 GREEN HEDGES WAY
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8189
Mailing Address - Country:US
Mailing Address - Phone:813-999-0505
Mailing Address - Fax:813-701-9450
Practice Address - Street 1:2236 GREEN HEDGES WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8189
Practice Address - Country:US
Practice Address - Phone:813-999-0505
Practice Address - Fax:813-701-9450
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66946207Q00000X, 207R00000X
AZ22493207R00000X
CAA55041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110144700Medicaid
FL25493OtherBLUE CROSS BLUE SHIELD
E96365Medicare UPIN