Provider Demographics
NPI:1740549260
Name:GUILLERMO VALENZUELA MD PA
Entity type:Organization
Organization Name:GUILLERMO VALENZUELA MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-476-2338
Mailing Address - Street 1:140 SW 84TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2736
Mailing Address - Country:US
Mailing Address - Phone:954-476-2338
Mailing Address - Fax:954-476-5695
Practice Address - Street 1:140 SW 84TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2736
Practice Address - Country:US
Practice Address - Phone:954-476-2338
Practice Address - Fax:954-476-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty