Provider Demographics
NPI:1891787784
Name:VALENTINO, VERNON A (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:A
Last Name:VALENTINO
Suffix:
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 80354
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0354
Mailing Address - Country:US
Mailing Address - Phone:337-534-4143
Mailing Address - Fax:337-534-4082
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BUILDING 1, SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6984
Practice Address - Country:US
Practice Address - Phone:337-534-4143
Practice Address - Fax:337-534-4082
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18323207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA272685OtherMC GRP PTAN
LA1916994Medicaid
LA272685OtherMC GRP PTAN
LA5N534DB73Medicare PIN
LA1916994Medicaid