Provider Demographics
NPI:1104232230
Name:VALENZUELA, GRACE MARIA (BA)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARIA
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10331 SW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7012
Mailing Address - Country:US
Mailing Address - Phone:305-965-9240
Mailing Address - Fax:
Practice Address - Street 1:1120 NW 14TH ST RM 1213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst