Provider Demographics
NPI:1295248441
Name:VALCO CONSULTING FIRM
Entity type:Organization
Organization Name:VALCO CONSULTING FIRM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WOJTEK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAJNOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:657-345-0572
Mailing Address - Street 1:1111 CANYON VIEW LN
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4713
Mailing Address - Country:US
Mailing Address - Phone:269-363-9715
Mailing Address - Fax:
Practice Address - Street 1:1111 CANYON VIEW LN
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4713
Practice Address - Country:US
Practice Address - Phone:269-363-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144692208D00000X
208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty