Provider Demographics
NPI:1205369972
Name:LASSALLE, VALENTINA STEVANOVICH (DO)
Entity Type:Individual
Prefix:MS
First Name:VALENTINA
Middle Name:STEVANOVICH
Last Name:LASSALLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 10TH ST N UNIT 1E
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1407
Mailing Address - Country:US
Mailing Address - Phone:727-824-3120
Mailing Address - Fax:727-824-7173
Practice Address - Street 1:620 10TH ST N UNIT 1E
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-3120
Practice Address - Fax:727-824-7173
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS16129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program