Provider Demographics
NPI:1518045525
Name:VALENCIA, RAFAEL LARDIZABAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:LARDIZABAL
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:146 LAKEVIEW DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026
Mailing Address - Country:US
Mailing Address - Phone:856-435-6530
Mailing Address - Fax:856-435-3206
Practice Address - Street 1:146 LAKEVIEW DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026
Practice Address - Country:US
Practice Address - Phone:856-435-6530
Practice Address - Fax:856-435-3206
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA41796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3976301Medicaid