Provider Demographics
NPI:1588553473
Name:VALENCIA, EDWIN (RDMS)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:
Other - Last Name:VALENCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDMS
Mailing Address - Street 1:3055 NW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1921
Mailing Address - Country:US
Mailing Address - Phone:786-720-5615
Mailing Address - Fax:
Practice Address - Street 1:3055 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1921
Practice Address - Country:US
Practice Address - Phone:786-720-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2866802085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty