Healthcare Provider Details

I. General information

NPI: 1164619284
Provider Name (Legal Business Name): JOHN P. VALENTIC, M.D. PC, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL DR
UKIAH CA
95482-4591
US

IV. Provider business mailing address

145 HOSPITAL DR
UKIAH CA
95482-4591
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-2227
  • Fax: 707-462-2547
Mailing address:
  • Phone: 707-462-2227
  • Fax: 707-462-2547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number00G432880
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number00G432880
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number00G432880
License Number StateCA

VIII. Authorized Official

Name: JOHN P. VALENTIC
Title or Position: PRESIDENT/OWNER
Credential: M. D.
Phone: 707-462-2227