Provider Demographics
NPI:1306670773
Name:VALDES MUGUERCIA, JOSE ANTONIO
Entity type:Individual
Prefix:
First Name:JOSE ANTONIO
Middle Name:
Last Name:VALDES MUGUERCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 NW 16TH STREET RD APT 402
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1391
Mailing Address - Country:US
Mailing Address - Phone:786-486-2536
Mailing Address - Fax:
Practice Address - Street 1:2415 NW 16TH STREET RD APT 402
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1391
Practice Address - Country:US
Practice Address - Phone:786-486-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9507603163W00000X
FL11034986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse