Provider Demographics
NPI:1366591679
Name:VALENCIA, HECTOR ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:ANTONIO
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 156TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3326
Mailing Address - Country:US
Mailing Address - Phone:718-779-5855
Mailing Address - Fax:718-779-1053
Practice Address - Street 1:3752 82ND ST
Practice Address - Street 2:2ND FL.
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7032
Practice Address - Country:US
Practice Address - Phone:718-779-5855
Practice Address - Fax:718-779-1053
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01321686Medicaid