Provider Demographics
NPI:1427445972
Name:VALDES, MARCO
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:VALDES
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 1:2720 SW 97TH AVE
Mailing Address - Street 2:# 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2677
Mailing Address - Country:US
Mailing Address - Phone:305-549-8085
Mailing Address - Fax:305-549-8790
Practice Address - Street 1:2720 SW 97TH AVE
Practice Address - Street 2:# 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2677
Practice Address - Country:US
Practice Address - Phone:305-549-8085
Practice Address - Fax:305-549-8790
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT67465247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist