Provider Demographics
NPI:1770628935
Name:VALENZUELA, MARTHA I (ST)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:I
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 E CALLE COLIMA
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-3470
Mailing Address - Country:US
Mailing Address - Phone:520-287-0800
Mailing Address - Fax:520-287-0816
Practice Address - Street 1:310 W PLUM ST
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2613
Practice Address - Country:US
Practice Address - Phone:520-287-0800
Practice Address - Fax:520-287-0816
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5295251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)