=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265612758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSE H VALLADARES MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2007
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2660 SW 3RD ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-541-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 450708
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33245-0708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-541-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSE H VALLADARES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-541-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | ME022220
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------