Provider Demographics
NPI:1225407190
Name:VALLADARES, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:VALLADARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 1/2 LUCILE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-6686
Mailing Address - Country:US
Mailing Address - Phone:213-352-0117
Mailing Address - Fax:
Practice Address - Street 1:12332 OSBORNE PL APT 17
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2084
Practice Address - Country:US
Practice Address - Phone:747-322-9526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner