Provider Demographics
NPI:1851390454
Name:VALENZUELA, MANUEL F (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:F
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 1:6633 N MESA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4422
Mailing Address - Country:US
Mailing Address - Phone:915-500-4093
Mailing Address - Fax:915-500-4167
Practice Address - Street 1:6633 N MESA ST STE 203
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4422
Practice Address - Country:US
Practice Address - Phone:915-726-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20030658208000000X
TXM1391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172867701Medicaid
NM94708266Medicaid
TX8AA317OtherBCBS
TX172867701Medicaid
TXP00674960OtherRAILROAD
TX172867701Medicaid