Healthcare Provider Details

I. General information

NPI: 1659728798
Provider Name (Legal Business Name): KEISHLA JANICE DEGRO VALLADARES MD, FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18533 SOLEDAD CANYON RD
SANTA CLARITA CA
91351-3722
US

IV. Provider business mailing address

18533 SOLEDAD CANYON RD
SANTA CLARITA CA
91351-3722
US

V. Phone/Fax

Practice location:
  • Phone: 616-738-8006
  • Fax:
Mailing address:
  • Phone: 661-673-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21334
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: