Provider Demographics
NPI:1649305608
Name:VALENCIA, CHRISTOPHER LINTAO (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LINTAO
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13940 N US HIGHWAY 441
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8908
Mailing Address - Country:US
Mailing Address - Phone:352-391-9057
Mailing Address - Fax:352-391-5992
Practice Address - Street 1:503 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5327
Practice Address - Country:US
Practice Address - Phone:318-329-4744
Practice Address - Fax:318-329-4719
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66948207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25587OtherBLUE CROSS BLUE SHIELD FL
FL130023931OtherRAILROAD MEDICARE
FL130023931OtherRAILROAD MEDICARE
FL25587XMedicare ID - Type Unspecified