Provider Demographics
NPI:1154550473
Name:VICTORIA VALDESUSO PA
Entity type:Organization
Organization Name:VICTORIA VALDESUSO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VALDESUSO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, ARNP
Authorized Official - Phone:786-263-3854
Mailing Address - Street 1:932 EUCLID AVE
Mailing Address - Street 2:APT #10
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-0821
Mailing Address - Country:US
Mailing Address - Phone:786-263-3854
Mailing Address - Fax:
Practice Address - Street 1:101 N OCEAN DR
Practice Address - Street 2:SUITE # 212
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-1728
Practice Address - Country:US
Practice Address - Phone:786-263-3854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6404314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54817Medicare PIN