Basic Information
| Provider Information | |||||||||
| NPI: | 1902275175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALLADARES | ||||||||
| FirstName: | FRITZI | ||||||||
| MiddleName: | MARIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 834 S RAITT ST APT 6 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927042924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146315409 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1556 S SULTANA AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917614238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094186923 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2015 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.