Provider Demographics
NPI:1396417952
Name:VALLADARES, FERNANDO DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:DAVID
Last Name:VALLADARES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 SINALOA RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5426
Mailing Address - Country:US
Mailing Address - Phone:805-428-2925
Mailing Address - Fax:
Practice Address - Street 1:400 S REINO RD STE 101
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4285
Practice Address - Country:US
Practice Address - Phone:805-277-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist