Provider Demographics
NPI:1952492290
Name:VALENZUELA, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 GRANDY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-6112
Mailing Address - Country:US
Mailing Address - Phone:904-398-1471
Mailing Address - Fax:904-398-1460
Practice Address - Street 1:1522 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6102
Practice Address - Country:US
Practice Address - Phone:904-396-3964
Practice Address - Fax:904-396-0128
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263972600Medicaid
FL263972606Medicaid
FL263972601Medicaid
FL263972604Medicaid
FL263972605Medicaid
FL263972602Medicaid
FL263972603Medicaid
FL273550400Medicaid