Provider Demographics
NPI:1366676918
Name:VALLADARES, LUIS EDUARDO (IDMT)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:EDUARDO
Last Name:VALLADARES
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:52D MEDICAL GROUP
Mailing Address - Street 2:SPANGDAHLEM, UNIT 3865
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09126-3865
Mailing Address - Country:US
Mailing Address - Phone:49656-561-8165
Mailing Address - Fax:
Practice Address - Street 1:PSC 118
Practice Address - Street 2:BOX 483
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09137-9998
Practice Address - Country:US
Practice Address - Phone:49656-167-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians