Provider Demographics
NPI:1851389589
Name:VALENZUELA, CARLOS A (ARNP)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2949
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2949
Mailing Address - Country:US
Mailing Address - Phone:907-262-3119
Mailing Address - Fax:
Practice Address - Street 1:805 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9104
Practice Address - Country:US
Practice Address - Phone:907-283-3600
Practice Address - Fax:907-262-9290
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURU1329363L00000X
FLARNP2968102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1581172Medicaid
FLQ47304Medicare UPIN
FL304851900Medicaid