Provider Demographics
NPI:1912400599
Name:VALENZUELA, JOSE IVAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:IVAN
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2270 JOE BATTLE BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2610
Mailing Address - Country:US
Mailing Address - Phone:915-855-7000
Mailing Address - Fax:915-855-7007
Practice Address - Street 1:2270 JOE BATTLE BLVD STE M
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2610
Practice Address - Country:US
Practice Address - Phone:915-855-7000
Practice Address - Fax:915-855-7007
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily