Healthcare Provider Details

I. General information

NPI: 1043905946
Provider Name (Legal Business Name): MARCO ANTONIO VALLADARES RENDEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5451 WALNUT AVE
CHINO CA
91710-2609
US

IV. Provider business mailing address

5451 WALNUT AVE
CHINO CA
91710-2609
US

V. Phone/Fax

Practice location:
  • Phone: 909-464-8609
  • Fax: 909-464-8616
Mailing address:
  • Phone: 909-464-8609
  • Fax: 909-464-8616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: