Provider Demographics
NPI:1093192486
Name:VALENTINE, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:VALENTINE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2683
Mailing Address - Country:US
Mailing Address - Phone:626-598-3770
Mailing Address - Fax:626-598-3797
Practice Address - Street 1:625 FAIR OAKS AVE STE 175
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2683
Practice Address - Country:US
Practice Address - Phone:626-598-3770
Practice Address - Fax:626-598-3797
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-1130052084N0400X
CA1692372084N0400X
CODR.00663172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology