Provider Demographics
NPI:1174239016
Name:MATONGOH, VALENTINE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:VALENTINE
Middle Name:
Last Name:MATONGOH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 S DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-3529
Mailing Address - Country:US
Mailing Address - Phone:303-778-7433
Mailing Address - Fax:
Practice Address - Street 1:3515 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-3529
Practice Address - Country:US
Practice Address - Phone:303-778-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant