Provider Demographics
NPI:1780850248
Name:LEONARD A. VALENTINO, MD, INC
Entity Type:Organization
Organization Name:LEONARD A. VALENTINO, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VALENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-363-5206
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13143207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG13143OtherSTATE LICENSE
CA00G131432Medicare PIN
CAA38897Medicare UPIN