Provider Demographics
NPI:1508847088
Name:VALENZUELA, OSVALDO F (MD)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:F
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 S CONGRESS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6614
Mailing Address - Country:US
Mailing Address - Phone:561-965-7228
Mailing Address - Fax:561-965-0120
Practice Address - Street 1:5503 S CONGRESS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6614
Practice Address - Country:US
Practice Address - Phone:561-965-7228
Practice Address - Fax:561-965-0120
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77932174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390007335OtherRR MEDICARE
FL46400OtherBLUE CROSS BLUE SHIELD
FL257566300Medicaid
FL257566300Medicaid
FLG91090Medicare UPIN