Provider Demographics
NPI:1649437526
Name:VALLADARES, LEONARDO LARRY
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:LARRY
Last Name:VALLADARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NAPA VALLEJO HWY
Mailing Address - Street 2:NSH BLDG M1 M2
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6234
Mailing Address - Country:US
Mailing Address - Phone:707-603-1112
Mailing Address - Fax:707-603-1117
Practice Address - Street 1:2100 NAPA VALLEJO HWY
Practice Address - Street 2:NSH BLDG M1 M2
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-603-1112
Practice Address - Fax:707-603-1117
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI-V0801291742101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)