Provider Demographics
NPI:1326591074
Name:VALLES, LEONOR IRLANDA (16483)
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:IRLANDA
Last Name:VALLES
Suffix:
Gender:F
Credentials:16483
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6980 ULMERTON RD APT 7E
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4965
Mailing Address - Country:US
Mailing Address - Phone:727-666-8834
Mailing Address - Fax:
Practice Address - Street 1:6980 ULMERTON RD APT 7E
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4965
Practice Address - Country:US
Practice Address - Phone:727-666-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16483246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL214038323OtherEMPLOYMENT AUTHORIZATION CARD