Provider Demographics
NPI:1770512204
Name:VALENZUELA, PETER MICHEAL (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHEAL
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST FL 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3440
Practice Address - Fax:916-733-3408
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8990207Q00000X
WAMD60122586207Q00000X
CAC56187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0258746OtherL&I AND CRIME VICTIMS
WA1770512204Medicaid
WA0055VAOtherREGENCE
WA8564122Medicaid
WA7643446OtherAETNA
WA0258746OtherL&I AND CRIME VICTIMS
WAG8888982Medicare PIN