Provider Demographics
NPI:1275794885
Name:VALENZUELA, ROLANDO GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:GABRIEL
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:436 SW 15TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1011
Mailing Address - Country:US
Mailing Address - Phone:917-439-1662
Mailing Address - Fax:
Practice Address - Street 1:HSC LEVEL 4 RM 080
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-2478
Practice Address - Fax:323-226-6465
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA121092207P00000X
NJ207P00000X
NY2883733207P00000X
TN53074207P00000X
FLME160487207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH$$$$$$$$$OtherSSN