Healthcare Provider Details

I. General information

NPI: 1558350108
Provider Name (Legal Business Name): SARA VALLADOLID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 265 WEST AND JUNCTION 191 SOUTH SAGE MEMORIAL HOSPITAL
GANADO AZ
86505
US

IV. Provider business mailing address

PO BOX 457 SAGE MEMORIAL HOSPITAL
GANADO AZ
86505-0457
US

V. Phone/Fax

Practice location:
  • Phone: 928-755-4500
  • Fax: 928-755-4659
Mailing address:
  • Phone: 928-755-4500
  • Fax: 928-755-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34392
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: