Provider Demographics
NPI:1063420396
Name:VALENZUELA, RAFAEL ERNESTO (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ERNESTO
Last Name:VALENZUELA
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Gender:M
Credentials:MEDICAL DOCTOR
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Mailing Address - Street 1:720 E TIDWELL RD
Mailing Address - Street 2:720 E. TIDWELL RD.
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-1822
Mailing Address - Country:US
Mailing Address - Phone:713-691-0035
Mailing Address - Fax:713-691-2448
Practice Address - Street 1:720 E TIDWELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-1822
Practice Address - Country:US
Practice Address - Phone:713-691-0035
Practice Address - Fax:713-691-2448
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF7948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27221Medicare UPIN