Healthcare Provider Details

I. General information

NPI: 1851390454
Provider Name (Legal Business Name): MANUEL F VALENZUELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 N MESA ST STE 203
EL PASO TX
79912-4422
US

IV. Provider business mailing address

6633 N MESA ST STE 203
EL PASO TX
79912-4422
US

V. Phone/Fax

Practice location:
  • Phone: 915-726-2175
  • Fax:
Mailing address:
  • Phone: 915-500-4093
  • Fax: 915-500-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20030658
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM1391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: