Provider Demographics
NPI:1386272672
Name:VALLADARES, JUAN ANDRES (DO)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANDRES
Last Name:VALLADARES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5978 SW 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-6009
Mailing Address - Country:US
Mailing Address - Phone:786-200-9854
Mailing Address - Fax:
Practice Address - Street 1:14000 FIVAY RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7103
Practice Address - Country:US
Practice Address - Phone:727-819-2966
Practice Address - Fax:727-819-2928
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18613207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine