MEDICARE: ENDRINA MANGUAL VALLADARES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	24531	PR

General Provider Information

NPI Number	:	1023707312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENDRINA MANGUAL VALLADARES MD

Provider Business Mailing Address
First Line	:	PO BOX 660
Second Line	:
City	:	BOQUERON
State	:	PR
Zip	:	00622-0660
Country	:	US
Telephone Number	:	787-428-8838
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR #2 KM 11.6
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00956-0956
Country	:	US
Telephone Number	:	787-474-8282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	06/08/2026

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