Healthcare Provider Details

I. General information

NPI: 1740549260
Provider Name (Legal Business Name): GUILLERMO VALENZUELA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SW 84TH AVE SUITE B
PLANTATION FL
33324-2736
US

IV. Provider business mailing address

140 SW 84TH AVE SUITE B
PLANTATION FL
33324-2736
US

V. Phone/Fax

Practice location:
  • Phone: 954-476-2338
  • Fax: 954-476-5695
Mailing address:
  • Phone: 954-476-2338
  • Fax: 954-476-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: GUILLERMO VALENZUELA
Title or Position: PRESIDENT
Credential: MD
Phone: 954-476-2338