Provider Demographics
NPI:1164849113
Name:DE LARA, VALERIE GRACE TORRES (MD)
Entity type:Individual
Prefix:
First Name:VALERIE GRACE
Middle Name:TORRES
Last Name:DE LARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIE GRACE
Other - Middle Name:DE LARA
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3872 SAN JOSE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4613
Mailing Address - Country:US
Mailing Address - Phone:904-773-4330
Mailing Address - Fax:
Practice Address - Street 1:3872 SAN JOSE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4613
Practice Address - Country:US
Practice Address - Phone:904-773-4330
Practice Address - Fax:360-462-5822
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136164208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics