Doctor Name: | MR. RODOLFO VALENZUELA |
NPI Number: | 1740367374 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP |
License Number: | 9209973 |
Business Practice Address: | 1914 E. Juan Sanchez Blvd. 2 San Luis, AZ - 853496805 |
Business Phone Number: | 9286272055 |
Business Fax Number: | 9286272456 |
Mailing Address: | Po Box 7053, 1914 E. Juan Sanchez Blvd. Ste. 2 SAN LUIS |
State: | AZ |
Postal Code: | 853496805 |
Phone Number: | 9286272055 |
Fax Number: | 9286272456 |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 9209973 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |