Provider Demographics
NPI:1497267686
Name:VALLADARES, ANGEL L (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:VALLADARES
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 SW 138TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2750
Mailing Address - Country:US
Mailing Address - Phone:201-245-2455
Mailing Address - Fax:
Practice Address - Street 1:1153 SW 138TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2750
Practice Address - Country:US
Practice Address - Phone:201-245-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9341366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily