Provider Demographics
NPI:1063824274
Name:VALENZUELA, MICHAEL A SR (SA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:VALENZUELA
Suffix:SR
Gender:M
Credentials:SA-C
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Mailing Address - Street 1:1830 E BROADWAY BLVD
Mailing Address - Street 2:PMB 124-114
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5966
Mailing Address - Country:US
Mailing Address - Phone:520-349-4979
Mailing Address - Fax:520-647-9174
Practice Address - Street 1:1830 E BROADWAY BLVD
Practice Address - Street 2:PMB 124-114
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5966
Practice Address - Country:US
Practice Address - Phone:520-349-4979
Practice Address - Fax:520-647-9174
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2015-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ14-258246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant