Provider Demographics
NPI:1508902172
Name:VALERA, AUGUSTO BAGOYO JR (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:BAGOYO
Last Name:VALERA
Suffix:JR
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:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94017
Mailing Address - Country:US
Mailing Address - Phone:650-296-2870
Mailing Address - Fax:650-754-1531
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-296-2870
Practice Address - Fax:650-754-1531
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82269208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A822690Medicaid
00A822690Medicare ID - Type Unspecified
00A822690Medicare UPIN