MEDICARE: DR. ARMANDO VALLADARES SAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	12-121	AZ

General Provider Information

NPI Number	:	1093065161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARMANDO VALLADARES SAC

Provider Business Mailing Address
First Line	:	1075 93 RD ST APT 402
Second Line	:
City	:	BAY HARBOR ISLD
State	:	FL
Zip	:	33154
Country	:	US
Telephone Number	:	786-301-5301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 93RD ST APT 402
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2352
Country	:	US
Telephone Number	:	786-301-5301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	09/14/2012

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