Provider Demographics
NPI:1104095645
Name:PAUL L VALENZA
Entity type:Organization
Organization Name:PAUL L VALENZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENZA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:830-895-7788
Mailing Address - Street 1:316 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4242
Mailing Address - Country:US
Mailing Address - Phone:830-895-7788
Mailing Address - Fax:830-895-7794
Practice Address - Street 1:316 W WATER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4242
Practice Address - Country:US
Practice Address - Phone:830-895-7788
Practice Address - Fax:830-895-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0997213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018751001Medicaid
TX00JD88Medicare PIN
TX018751001Medicaid
TX0390790001Medicare NSC