Provider Demographics
NPI:1689834566
Name:VALENCIA, GINA M (MMHE)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:M
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:MMHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 SOUTH MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133
Mailing Address - Country:US
Mailing Address - Phone:305-285-2994
Mailing Address - Fax:305-860-4678
Practice Address - Street 1:3510 BISCAYNE BLVD # 300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-285-2994
Practice Address - Fax:305-860-4678
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6875670000Medicaid