Provider Demographics
NPI:1528323052
Name:RUDDY A VALDES D.O., P.A.
Entity type:Organization
Organization Name:RUDDY A VALDES D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-562-0873
Mailing Address - Street 1:3600 RED RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6013
Mailing Address - Country:US
Mailing Address - Phone:305-562-0873
Mailing Address - Fax:305-726-0041
Practice Address - Street 1:3600 RED RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6013
Practice Address - Country:US
Practice Address - Phone:305-562-0873
Practice Address - Fax:305-726-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty