Active NPI
Jennifer Valladares, RPA-C
- Physician Assistant
- Brooklyn, NY
National Provider Identifier
1366584633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 54334
- Practice address
- 827 Prospect PL
Brooklyn, NY 11216-4074 - Phone
- (917) 716-3810
- NPI assigned
- Feb 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 0060129-1 | NY | |
| Physician Assistant | 363A00000X | 54334 | CA | Primary |
Addresses
Primary practice location
827 Prospect PL
Brooklyn, NY 11216-4074
Mailing address
827 Prospect PL
Brooklyn, NY 11216-4074
Phone (917) 716-3810
Other practice location 1
3401 Centre Lake Dr Ste 470
Ontario, CA 91761-1254
Phone (909) 566-0445
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54334 | Other | CA | CA STATE LICENSE NUMBER |
| 006129-1 | Other | NY | NY STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0060129-1 | NY | MD | Surgical Physician Assistant |
Interoperability endpoints
- jvalladares@landmarkhealth-direct.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736726400000",
"number": "1366584633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "827 PROSPECT PL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112164074",
"telephone_number": "917-716-3810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "827 PROSPECT PL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112164074",
"telephone_number": "917-716-3810"
}
],
"practiceLocations": [
{
"address_1": "3401 Centre Lake Dr Ste 470",
"address_purpose": "LOCATION",
"city": "Ontario",
"state": "CA",
"postal_code": "917611254",
"country_code": "US",
"telephone_number": "909-566-0445",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VALLADARES",
"first_name": "JENNIFER",
"name_prefix": "Miss",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2025-01-13",
"certification_date": "2025-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NY",
"license": "0060129-1",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "54334",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA STATE LICENSE NUMBER",
"identifier": "54334",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY STATE LICENSE NUMBER",
"identifier": "006129-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.