Provider Demographics
NPI:1912096371
Name:VALCARENGHI, GERARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:R
Last Name:VALCARENGHI
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 1:130 INDEPENDENCE CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4918
Mailing Address - Country:US
Mailing Address - Phone:530-343-5864
Mailing Address - Fax:530-343-8370
Practice Address - Street 1:130 INDEPENDENCE CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4918
Practice Address - Country:US
Practice Address - Phone:530-343-5864
Practice Address - Fax:530-343-8370
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A358670Medicaid
CA00A358670Medicaid
CAA27924Medicare UPIN