Individual
MR. DIMAS JOSE VALENTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-5119
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103371
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015905500
—
FL
01
—
OT11174
FL OTR/L LICENCE NUMBER
FL
01
—
PA9103371
FL PA LICENCE NUMBER
FL
Enumeration date
12/04/2007
Last updated
03/16/2020
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