Provider Demographics
NPI:1689610537
Name:VALENTINO, LEONARD A (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:A
Last Name:VALENTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:77 BIRCH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1423
Mailing Address - Country:US
Mailing Address - Phone:650-363-5206
Mailing Address - Fax:650-364-2347
Practice Address - Street 1:77 BIRCH ST
Practice Address - Street 2:SUITE A
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1423
Practice Address - Country:US
Practice Address - Phone:650-363-5206
Practice Address - Fax:650-364-2347
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG13143207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG13143OtherMEDICAL LICENSE
CAG13143OtherMEDICAL LICENSE
CA00G131432Medicare ID - Type Unspecified