Provider Demographics
NPI:1760669154
Name:VALEDON, GLADYS A (MT)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:A
Last Name:VALEDON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 VIA MALLORCA
Mailing Address - Street 2:URB L ANTIGUA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-774-2845
Mailing Address - Fax:787-792-7842
Practice Address - Street 1:24 VIA MAYORCA
Practice Address - Street 2:URB L ANTIGUA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6101
Practice Address - Country:US
Practice Address - Phone:787-774-2845
Practice Address - Fax:787-792-7842
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2385246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist