=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679395081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLADARES HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2024
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16321 SW 76TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33193-3446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-800-4567
-----------------------------------------------------
Fax | 786-800-4567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16321 SW 76TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33193-3446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-800-4567
-----------------------------------------------------
Fax | 786-800-4567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDUARDO VALLADARES
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 786-800-4567
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------