Provider Demographics
NPI:1851066716
Name:VALENZUELA, DANIEL BROK
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BROK
Last Name: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 1:6358 EDGEMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3517
Mailing Address - Country:US
Mailing Address - Phone:915-562-8525
Mailing Address - Fax:915-566-3889
Practice Address - Street 1:6358 EDGEMERE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3517
Practice Address - Country:US
Practice Address - Phone:915-562-8525
Practice Address - Fax:915-566-3889
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2163342225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant