Healthcare Provider Details

I. General information

NPI: 1609205962
Provider Name (Legal Business Name): MANUEL F VALENZUELA MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 N MESA ST STE 202
EL PASO TX
79912-4427
US

IV. Provider business mailing address

4849 N MESA ST STE 201
EL PASO TX
79912-5916
US

V. Phone/Fax

Practice location:
  • Phone: 915-726-2175
  • Fax: 915-351-6601
Mailing address:
  • Phone: 915-351-6600
  • Fax: 915-351-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM1391
License Number StateTX

VIII. Authorized Official

Name: MANUEL F VALENZUELA
Title or Position: PRESIDENT
Credential: MDPA
Phone: 915-726-2175