Provider Demographics
NPI:1912624461
Name:VALENZUELA, JAIME ALEJANDRO
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ALEJANDRO
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ENNIS ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-8505
Mailing Address - Country:US
Mailing Address - Phone:915-803-1417
Mailing Address - Fax:
Practice Address - Street 1:9314 RYDER DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2000
Practice Address - Country:US
Practice Address - Phone:726-800-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician