Provider Demographics
NPI:1609205962
Name:MANUEL F VALENZUELA MDPA
Entity Type:Organization
Organization Name:MANUEL F VALENZUELA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:MDPA
Authorized Official - Phone:915-726-2175
Mailing Address - Street 1:4849 N MESA ST
Mailing Address - Street 2:STE 201
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5916
Mailing Address - Country:US
Mailing Address - Phone:915-351-6600
Mailing Address - Fax:915-351-6601
Practice Address - Street 1:6633 N MESA ST
Practice Address - Street 2:STE 202
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4427
Practice Address - Country:US
Practice Address - Phone:915-726-2175
Practice Address - Fax:915-351-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty