Healthcare Provider Details

I. General information

NPI: 1720303191
Provider Name (Legal Business Name): VALENTIN A. LANCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR RADIOLOGY DEPARTMENT
LA MESA CA
91942-3019
US

IV. Provider business mailing address

5555 GROSSMONT CENTER DR RADIOLOGY DEPARTMENT
LA MESA CA
91942-3019
US

V. Phone/Fax

Practice location:
  • Phone: 800-841-5200
  • Fax: 508-273-1241
Mailing address:
  • Phone: 619-740-4008
  • Fax: 619-740-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA118759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: