Provider Demographics
NPI:1356495386
Name:UKIAH OBSTETRICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:UKIAH OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-462-2945
Mailing Address - Street 1:1101 SOUTH DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-462-2945
Mailing Address - Fax:707-462-0474
Practice Address - Street 1:1101 SOUTH DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-462-2945
Practice Address - Fax:707-462-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G288730Medicaid
A43894Medicare UPIN
CA00G288730Medicaid