Provider Demographics
NPI:1104858521
Name:VALENZUELA, ROBERTO CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CHRISTIAN
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3466
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-8816
Mailing Address - Fax:
Practice Address - Street 1:2000 MON HEALTH MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-720-8816
Practice Address - Fax:904-494-6467
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.079981207L00000X
SC22635207L00000X
PAMD465074207L00000X
NC2018-00825207L00000X
WV15563207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00035442OtherRR MEDICARE
OH2460484Medicaid
WV270052997004OtherTRICARE
WV0207026000Medicaid
WVDA0096OtherRR MEDICARE
OH0841790Medicaid
WV0059444000Medicaid
PA643157OtherGROUP MEDICARE
WV0881786Medicare PIN
WVE97626Medicare UPIN
WVP00377022OtherRR MEDICARE
WV270052997004OtherTRICARE
WV27005299700OtherBRICKSTREET
WV2122544OtherALLIANCE
WVE97626Medicare UPIN
WV0881787Medicare PIN
WVDA0096OtherRR MEDICARE
WV20554238700OtherWORKERS COMP
OH2460484Medicaid
WV0207026000Medicaid
OH0841790Medicaid
WV3810006746Medicaid
WV0059444000Medicaid
WV001706469OtherMSBCBS GROUP
WV9333201Medicare PIN