Provider Demographics
NPI:1568457547
Name:VALLADARES, NAVIJA H (MD)
Entity Type:Individual
Prefix:
First Name:NAVIJA
Middle Name:H
Last Name:VALLADARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7094
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:315 E OLYMPIA AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3823
Practice Address - Country:US
Practice Address - Phone:941-205-2600
Practice Address - Fax:941-205-2601
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47667OtherBCBS
FL1519288002OtherCIGNA
FLD55136Medicare UPIN
FL47667RMedicare PIN