Provider Demographics
NPI:1982986998
Name:VALANT MEDICAL, PA
Entity type:Organization
Organization Name:VALANT MEDICAL, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:POTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-626-9326
Mailing Address - Street 1:2598 SW HIDDEN POND WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2053
Mailing Address - Country:US
Mailing Address - Phone:772-626-9326
Mailing Address - Fax:
Practice Address - Street 1:611 SW FEDERAL HWY
Practice Address - Street 2:SUITE E
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:772-626-9326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALANT MEDICAL, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10791207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty