Healthcare Provider Details

I. General information

NPI: 1326137480
Provider Name (Legal Business Name): AMADEO VALENZUELA JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W COLORADO AVE
RIO HONDO TX
78583
US

IV. Provider business mailing address

PO BOX 800
RIO HONDO TX
78583-0800
US

V. Phone/Fax

Practice location:
  • Phone: 956-748-2141
  • Fax: 956-748-2570
Mailing address:
  • Phone: 956-748-2141
  • Fax: 956-748-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0197
License Number StateTX

VIII. Authorized Official

Name: AMADEO VALENZUELA
Title or Position: PRESIDENT
Credential:
Phone: 956-748-2141