Provider Demographics
NPI:1235152232
Name:VALICENTI, RICHARD K (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:VALICENTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 X STREET
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2229
Mailing Address - Country:US
Mailing Address - Phone:916-734-8295
Mailing Address - Fax:916-734-3239
Practice Address - Street 1:4501 X STREET
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2229
Practice Address - Country:US
Practice Address - Phone:916-734-8295
Practice Address - Fax:916-734-3239
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-055463-L2085R0001X
CAG884422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6908403Medicaid
PA001534833Medicaid
PA778406Medicare PIN