Provider Demographics
NPI:1225690340
Name:VALLADARES, CAROLINE A (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:A
Last Name:VALLADARES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 MONSERATE AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2326
Mailing Address - Country:US
Mailing Address - Phone:619-977-4241
Mailing Address - Fax:
Practice Address - Street 1:949 MONSERATE AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2326
Practice Address - Country:US
Practice Address - Phone:619-977-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95131693163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse