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Individual
DR. THERESA LYNN VALLADARES
Active
Individual
DR. THERESA LYNN VALLADARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K4822
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011MP
BCBS PROVIDER #
TX
05
—
148012102
—
TX
05
—
173167101
—
TX
05
—
173167102
—
TX
01
—
742925774
TAX ID
TX
Enumeration date
08/22/2006
Last updated
01/14/2011
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