Provider Demographics
NPI:1285272187
Name:PADRON VALDES, ODALYS BARBARA
Entity type:Individual
Prefix:
First Name:ODALYS
Middle Name:BARBARA
Last Name:PADRON VALDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20062 NW 66TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2139
Mailing Address - Country:US
Mailing Address - Phone:786-715-3361
Mailing Address - Fax:
Practice Address - Street 1:18505 NW 75TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2961
Practice Address - Country:US
Practice Address - Phone:786-479-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-58474106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty