Provider Demographics
NPI:1558541375
Name:GAUDIA, VALENTINO VILLAZOR (SFIDC)
Entity Type:Individual
Prefix:
First Name:VALENTINO
Middle Name:VILLAZOR
Last Name:GAUDIA
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MWSS 172 MEDICAL
Mailing Address - Street 2:UNIT 37206
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96603
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MWSS 172 MEDICAL
Practice Address - Street 2:UNIT 37206
Practice Address - City:FPO
Practice Address - State:JP
Practice Address - Zip Code:AP
Practice Address - Country:JP
Practice Address - Phone:645-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman