Provider Demographics
NPI:1801995410
Name:VALENTINE, DONNA HOLZHAUER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:HOLZHAUER
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3851
Mailing Address - Country:US
Mailing Address - Phone:714-541-0101
Mailing Address - Fax:714-619-3322
Practice Address - Street 1:363 S MAIN ST STE 485
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3833
Practice Address - Country:US
Practice Address - Phone:714-835-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15076363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10689Medicare ID - Type Unspecified