Provider Demographics
NPI:1306940473
Name:VALDOVINOS, LAURA GEORGINA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GEORGINA
Last Name:VALDOVINOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5887 BROCKTON AVE
Mailing Address - Street 2:SUITE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506
Mailing Address - Country:US
Mailing Address - Phone:951-275-8500
Mailing Address - Fax:951-275-8560
Practice Address - Street 1:5887 BROCKTON AVE
Practice Address - Street 2:SUITE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-275-8500
Practice Address - Fax:951-275-8560
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG760742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G760742Medicare ID - Type Unspecified
F66471Medicare UPIN