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General NPI Number Information
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NPI Number | 1295999589
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Entity Type | Individual
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Provider Name | NASA VALENTINE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 10/16/2021
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Provider Practice Location Address
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Address Line | 6020 SEABLUFF DR
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City | PLAYA VISTA
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State | CA
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Zip | 90094-2252
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Country | US
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Telephone | 310-862-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 3862 CLAREMONT ST
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City | IRVINE
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State | CA
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Zip | 92614-6617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036121819
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A102556
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License Number State | CA
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