Provider Demographics
NPI:1710636006
Name:AGUILAR-VALENZUELA, RENAN ANTONIO
Entity Type:Individual
Prefix:
First Name:RENAN
Middle Name:ANTONIO
Last Name:AGUILAR-VALENZUELA
Suffix:
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 1:401 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-4000
Mailing Address - Country:US
Mailing Address - Phone:254-215-0905
Mailing Address - Fax:
Practice Address - Street 1:401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-4000
Practice Address - Country:US
Practice Address - Phone:254-215-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program