Healthcare Provider Details

I. General information

NPI: 1760464077
Provider Name (Legal Business Name): RICHARD J VALENTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SAINT FRANCIS DR STE 320
WATERLOO IA
50702-5620
US

IV. Provider business mailing address

2710 SAINT FRANCIS DR STE 320
WATERLOO IA
50702-5620
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-5000
  • Fax: 319-272-8072
Mailing address:
  • Phone: 319-272-5000
  • Fax: 319-272-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG053461
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG053461
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD-37534
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-37534
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: