Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G43288 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G43288 | CA |
N | 207NS0135X | Procedural Dermatology | G43288 | CA |
NPI | 1104963008 |
---|---|
Provider Name | John Valentic |
First Address | Ukiah, CA 95482-4591 |
Second Address | Ukiah, CA 95482-4591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 01/10/2007 |