Provider Demographics
NPI:1245336395
Name:VALENZUELA, PIO II (MD)
Entity type:Individual
Prefix:DR
First Name:PIO
Middle Name:
Last Name:VALENZUELA
Suffix:II
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 1:107 GAMMA DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2936
Mailing Address - Country:US
Mailing Address - Phone:412-963-6677
Mailing Address - Fax:412-963-6868
Practice Address - Street 1:107 GAMMA DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2936
Practice Address - Country:US
Practice Address - Phone:412-963-6677
Practice Address - Fax:412-963-6868
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042756208200000X
KY24905208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4847125Medicaid
MI2403312691OtherBCBS INDIVIDUAL PIN
KY7100244120Medicaid
NY03206104Medicaid
PA1024359950001Medicaid
MI200000001285OtherPHP PIN #
MI200000001285OtherPHP PIN #
MI4847125Medicaid
NY03206104Medicaid
PA1024359950001Medicaid
KYK090010Medicare PIN