Provider Demographics
NPI:1083697080
Name:VALENZA, PAUL L
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:VALENZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4242
Mailing Address - Country:US
Mailing Address - Phone:830-895-7788
Mailing Address - Fax:
Practice Address - Street 1:316 W WATER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4242
Practice Address - Country:US
Practice Address - Phone:830-895-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0997213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018751001Medicaid
TXT16383Medicare UPIN
TX018751001Medicaid
TX00JD88Medicare PIN