Basic Information
Provider Information
NPI: 1790249480
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VALLADARES
FirstName: LORELEIN
MiddleName: NEREIDA
NamePrefix: MS.
NameSuffix:  
Credential: CRNA, ARNP, DNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8255 SW 72ND CT UNIT 113
Address2:  
City: MIAMI
State: FL
PostalCode: 331434257
CountryCode: US
TelephoneNumber: 3053384253
FaxNumber:  
Practice Location
Address1: 6200 SW 73RD ST
Address2:  
City: SOUTH MIAMI
State: FL
PostalCode: 331434679
CountryCode: US
TelephoneNumber: 7866624000
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/26/2019
LastUpdateDate: 01/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X125413FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


Home