Provider Demographics
NPI:1710597174
Name:VALENZUELA CORTEZ, GUILLERMO MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:MIGUEL
Last Name:VALENZUELA CORTEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:205 S FRONT ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1619
Mailing Address - Country:US
Mailing Address - Phone:717-231-8532
Mailing Address - Fax:717-231-8535
Practice Address - Street 1:205 S FRONT ST STE 3C
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1619
Practice Address - Country:US
Practice Address - Phone:717-231-8532
Practice Address - Fax:717-231-8535
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT222042207R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine