Provider Demographics
NPI:1164803078
Name:VALLADARES GONZALEZ, MANUEL (APRN)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:VALLADARES GONZALEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 NW 79TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-5683
Mailing Address - Country:US
Mailing Address - Phone:786-508-3896
Mailing Address - Fax:
Practice Address - Street 1:2141 SW 1ST ST STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-5601
Practice Address - Country:US
Practice Address - Phone:305-649-3336
Practice Address - Fax:305-649-3929
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11039712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily