=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093192486
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ALBERT VALENTINE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2015
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 FAIR OAKS AVE STE 175
-----------------------------------------------------
City | SOUTH PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91030-2683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-598-3770
-----------------------------------------------------
Fax | 626-598-3797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 FAIR OAKS AVE STE 175
-----------------------------------------------------
City | SOUTH PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91030-2683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-598-3770
-----------------------------------------------------
Fax | 626-598-3797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 2025-00074
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-113005
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 169237
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | DR.0066317
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------