Provider Demographics
NPI:1770819393
Name:VIALPANDO, JOHN RYAN (BS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RYAN
Last Name:VIALPANDO
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3470 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1520
Mailing Address - Country:US
Mailing Address - Phone:719-561-9850
Mailing Address - Fax:719-545-4097
Practice Address - Street 1:3470 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1520
Practice Address - Country:US
Practice Address - Phone:719-561-9850
Practice Address - Fax:719-545-4097
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO84 0810723324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility