Healthcare Provider Details

I. General information

NPI: 1033128392
Provider Name (Legal Business Name): STEPHEN RAY VALENZUELA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W JACKSON ST
PECOS TX
79772-4719
US

IV. Provider business mailing address

1800 W JACKSON ST
PECOS TX
79772-4719
US

V. Phone/Fax

Practice location:
  • Phone: 432-447-2266
  • Fax: 432-447-3909
Mailing address:
  • Phone: 432-447-2266
  • Fax: 432-447-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33529
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: