MEDICARE: VALORA MEDICAL GROUP LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1841871803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALORA MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	9369 BLANCHE COVE DRIVE
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786
Country	:	US
Telephone Number	:	407-460-1292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-6422
Country	:	US
Telephone Number	:	844-825-6724
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	PATRICIA D PICHARDO
Credential	:
Telephone Number	:	407-460-1292

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/20/2021

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