Provider Demographics
NPI:1033524988
Name:RODOLFO C. VALENZUELA LLC
Entity Type:Organization
Organization Name:RODOLFO C. VALENZUELA LLC
Other - Org Name:RODOLFO C. VALENZUELA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,SA
Authorized Official - Phone:240-328-9784
Mailing Address - Street 1:18302 ASHMEADE RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4387
Mailing Address - Country:US
Mailing Address - Phone:240-328-9784
Mailing Address - Fax:
Practice Address - Street 1:18302 ASHMEADE RD
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-4387
Practice Address - Country:US
Practice Address - Phone:240-328-9784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-29
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty