Provider Demographics
NPI:1134305477
Name:GUILLERMO VALENZUELA, MD,PA
Entity Type:Organization
Organization Name:GUILLERMO VALENZUELA, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-476-2338
Mailing Address - Street 1:7542 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1317
Mailing Address - Country:US
Mailing Address - Phone:561-357-7884
Mailing Address - Fax:561-760-0265
Practice Address - Street 1:140 SW 84TH AVE
Practice Address - Street 2:# B
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2736
Practice Address - Country:US
Practice Address - Phone:954-476-2338
Practice Address - Fax:954-476-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378648000Medicaid
FL25333AMedicare PIN