MEDICARE: CARLOS VALENZUELA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508876442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS VALENZUELA

Provider Business Mailing Address
First Line	:	4224 OHIO ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1320
Country	:	US
Telephone Number	:	619-280-9174
Fax Number	:	619-280-9286

Provider Business Practice Location Address
First Line	:	4224 OHIO ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1320
Country	:	US
Telephone Number	:	619-280-9174
Fax Number	:	619-280-9286

Authorized Official
Title or Position	:	CERTIFIED ORTHOTIST OWNER
Name	:	CARLOS VALENZUELA
Credential	:
Telephone Number	:	619-280-9174

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	09/09/2008

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Directions to “CARLOS VALENZUELA ” Practice Location

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