Healthcare Provider Details

I. General information

NPI: 1528962610
Provider Name (Legal Business Name): JOSUE RAUL VALENZUELA MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N GRAND COURT PLZ
NOGALES AZ
85621-2746
US

IV. Provider business mailing address

1155 N SENECA PL
NOGALES AZ
85621-1550
US

V. Phone/Fax

Practice location:
  • Phone: 520-839-2682
  • Fax:
Mailing address:
  • Phone: 520-839-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberAZ00015140
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: