Healthcare Provider Details

I. General information

NPI: 1891787784
Provider Name (Legal Business Name): VERNON A VALENTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AMBASSADOR CAFFERY PKWY BUILDING 1, SUITE 100
LAFAYETTE LA
70508-6984
US

IV. Provider business mailing address

PO BOX 80354
LAFAYETTE LA
70598-0354
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-4143
  • Fax: 337-534-4082
Mailing address:
  • Phone: 337-534-4143
  • Fax: 337-534-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18323
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: