Provider Demographics
NPI:1295024628
Name:VALENZUELA, JORGE ARTURO (LPN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ARTURO
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-4517
Mailing Address - Country:US
Mailing Address - Phone:623-691-4085
Mailing Address - Fax:
Practice Address - Street 1:13511 N 153RD AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-9139
Practice Address - Country:US
Practice Address - Phone:480-458-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP960998164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse