Basic Information
| Provider Information | |||||||||
| NPI: | 1568457547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALLADARES | ||||||||
| FirstName: | NAVIJA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3434 HANCOCK BRIDGE PKWY | ||||||||
| Address2: | |||||||||
| City: | N FT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339037094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778563774 | ||||||||
| FaxNumber: | 2395992625 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 E OLYMPIA AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412052600 | ||||||||
| FaxNumber: | 9412052601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME45367 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 47667 | 01 | FL | BCBS | OTHER | 1519288002 | 01 | FL | CIGNA | OTHER |