Provider Demographics
NPI:1285664755
Name:VALENCIA, JOSE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:101 E RIDGE RD
Mailing Address - Street 2:LABORATORY DEPARTMENT
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1248
Mailing Address - Country:US
Mailing Address - Phone:956-632-6405
Mailing Address - Fax:956-632-6641
Practice Address - Street 1:101 E RIDGE RD
Practice Address - Street 2:LABORATORY DEPARTMENT
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1248
Practice Address - Country:US
Practice Address - Phone:956-632-6405
Practice Address - Fax:956-632-6641
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4730207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81P863Medicare ID - Type Unspecified
TXE28666Medicare UPIN