Provider Demographics
NPI:1356491971
Name:VALENTIN, LEOCADIO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:LEOCADIO
Middle Name:ANTONIO
Last Name:VALENTIN
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 1:4711 SPICEWOOD SPRINGS RD APT 279
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8433
Mailing Address - Country:US
Mailing Address - Phone:512-349-2309
Mailing Address - Fax:512-349-2309
Practice Address - Street 1:4711 SPICEWOOD SPRINGS RD APT 279
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8433
Practice Address - Country:US
Practice Address - Phone:512-349-2309
Practice Address - Fax:512-349-2309
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4597208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG65004Medicare UPIN