MEDICARE: MANUEL F VALENZUELA MDPA

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	208000000X	Pediatrics Physician	M1391	TX

General Provider Information

NPI Number	:	1609205962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANUEL F VALENZUELA MDPA

Provider Business Mailing Address
First Line	:	4849 N MESA ST
Second Line	:	STE 201
City	:	EL PASO
State	:	TX
Zip	:	79912-5916
Country	:	US
Telephone Number	:	915-351-6600
Fax Number	:	915-351-6601

Provider Business Practice Location Address
First Line	:	6633 N MESA ST
Second Line	:	STE 202
City	:	EL PASO
State	:	TX
Zip	:	79912-4427
Country	:	US
Telephone Number	:	915-726-2175
Fax Number	:	915-351-6601

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MANUEL F VALENZUELA
Credential	:	MDPA
Telephone Number	:	915-726-2175

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	11/07/2013

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