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General NPI Number Information
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NPI Number | 1407087547
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Entity Type | Individual
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Provider Name | FLOR DE MARIA GRADOS VALDERRAMA M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 2802 PARGOUD BLVD
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City | MONROE
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State | LA
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Zip | 71201-2335
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Country | US
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Telephone | 305-766-9688
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Fax |
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Provider Business Mailing Address
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Address Line | 2802 PARGOUD BLVD
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City | MONROE
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State | LA
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Zip | 71201-2335
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 203138
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License Number State | LA
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