Provider Demographics
NPI:1710376504
Name:VALENZUELA, GUMERCINDO JR
Entity Type:Individual
Prefix:
First Name:GUMERCINDO
Middle Name:
Last Name:VALENZUELA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 MAGIC DR
Mailing Address - Street 2:STE. T21
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2973
Mailing Address - Country:US
Mailing Address - Phone:210-614-8101
Mailing Address - Fax:
Practice Address - Street 1:3463 MAGIC DR
Practice Address - Street 2:STE. T21
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2973
Practice Address - Country:US
Practice Address - Phone:210-614-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant