Healthcare Provider Details

I. General information

NPI: 1497486484
Provider Name (Legal Business Name): ROGELIO FERNANDO DEL VALLE VALLADARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 N 56TH ST
TAMPA FL
33617-1161
US

IV. Provider business mailing address

PO BOX 850001, DEPT 8340
ORLANDO FL
32885-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-988-1101
  • Fax: 813-989-3899
Mailing address:
  • Phone: 813-536-7277
  • Fax: 855-830-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number022696
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: