Healthcare Provider Details

I. General information

NPI: 1750834065
Provider Name (Legal Business Name): ENRIQUE J VALLADARES ROMERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ENRIQUE J VALLADARES ROMERO MD

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLUMBUS AVE STE 200E
VALHALLA NY
10595-1392
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL # SC05
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 914-490-0401
  • Fax:
Mailing address:
  • Phone: 559-267-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA159420
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT212199
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number329056
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: