Healthcare Provider Details

I. General information

NPI: 1942250188
Provider Name (Legal Business Name): GREGG A VALENZUELA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 E PARHAM RD SUITE 101
RICHMOND VA
23294-4371
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-7901
  • Fax: 804-273-9167
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101036504
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: