MEDICARE: DR. MARY GRACE VALENZUELA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME87191	FL

General Provider Information

NPI Number	:	1477663714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY GRACE VALENZUELA M.D.

Provider Business Mailing Address
First Line	:	4539 JUBILEE TRL
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32305-2337
Country	:	US
Telephone Number	:	206-849-1948
Fax Number	:

Provider Business Practice Location Address
First Line	:	4539 JUBILEE TRL
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32305-2337
Country	:	US
Telephone Number	:	206-849-1948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/18/2024

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