=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093065161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARMANDO VALLADARES SAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2012
-----------------------------------------------------
Last Update Date | 09/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1075 93RD ST APT 402
-----------------------------------------------------
City | BAY HARBOR ISLANDS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33154-2352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-301-5301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1075 93 RD ST APT 402
-----------------------------------------------------
City | BAY HARBOR ISLD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-301-5301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number | 12-121
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------