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General NPI Number Information
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NPI Number | 1164803078
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Entity Type | Individual
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Provider Name | MANUEL VALLADARES GONZALEZ APRN
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Gender | Male
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 15700 NW 67TH AVE STE 102
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2112
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Country | US
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Telephone | 786-434-5987
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Fax | 786-434-5988
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Provider Business Mailing Address
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Address Line | PO BOX 4189
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-4189
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Country | US
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Telephone | 954-363-9582
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11039712
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License Number State | FL
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