Provider Demographics
NPI:1801063730
Name:VALLADARES OTERO, ANGELA (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:VALLADARES OTERO
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:12631 EAST 17TH AVENUE. AO1, RM 2414.
Practice Address - Street 2:ANSCHUTZ MEDICAL CAMPUS. RADIOLOGY
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2816
Practice Address - Country:US
Practice Address - Phone:303-724-1980
Practice Address - Fax:303-724-1983
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO511542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12155063Medicaid
CO12155063Medicaid