Provider Demographics
NPI:1366565228
Name:MIREA, VALENTIN (AP, DOM)
Entity type:Individual
Prefix:MR
First Name:VALENTIN
Middle Name:
Last Name:MIREA
Suffix:
Gender:M
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712
Mailing Address - Country:US
Mailing Address - Phone:727-551-0857
Mailing Address - Fax:727-202-6896
Practice Address - Street 1:2520 CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712
Practice Address - Country:US
Practice Address - Phone:727-551-0857
Practice Address - Fax:727-202-6896
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2859171100000X
TX492171100000X
CO1218171100000X
FLAC2859171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1218OtherCOLORADO LICENCE
FL2859OtherFLORIDA