Provider Demographics
NPI:1740279702
Name:VALENTIN, LEONARDO IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:IVAN
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEONARDO
Other - Middle Name:IVAN
Other - Last Name:VALENTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 8973
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8973
Mailing Address - Country:US
Mailing Address - Phone:787-884-0505
Mailing Address - Fax:787-884-0510
Practice Address - Street 1:8 AVE LAS CUMBRES
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-740-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80640Medicaid
PR80640Medicare ID - Type Unspecified
PR80640Medicaid