Provider Demographics
NPI:1376684639
Name:VALENZUELA, DIANA R (LVNII)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:R
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:LVNII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 MORGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-427-8037
Mailing Address - Fax:956-427-8107
Practice Address - Street 1:711 N L STREET
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-427-8125
Practice Address - Fax:956-427-8126
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36889164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
X15233Medicare UPIN
TXPH0013Medicare ID - Type Unspecified