Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 036.096247 | IL |
Y | 207RH0003X | Hematology & Oncology | L5595 | TX |
NPI | 1053303255 |
---|---|
Provider Name | Dr. Jose Luis Valladares |
First Address | Victoria, TX 77901-6053 |
Second Address | Victoria, TX 77901-6053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 26/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H80935 | (02) |