Provider Demographics
NPI:1891269825
Name:VALLADARES OJEDA, IRIS (APRN)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:VALLADARES OJEDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7341 NW 174TH TER # A108
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-1132
Mailing Address - Country:US
Mailing Address - Phone:786-355-9196
Mailing Address - Fax:
Practice Address - Street 1:7341 NW 174TH TER # A-108
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-1132
Practice Address - Country:US
Practice Address - Phone:786-355-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9367607363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty