Provider Demographics
NPI:1154546810
Name:FSP HEALTH MINISTRIES
Entity type:Organization
Organization Name:FSP HEALTH MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-627-2055
Mailing Address - Street 1:PO BOX 7053
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349-6805
Mailing Address - Country:US
Mailing Address - Phone:928-627-2055
Mailing Address - Fax:928-627-2456
Practice Address - Street 1:780 N CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349
Practice Address - Country:US
Practice Address - Phone:928-627-2055
Practice Address - Fax:928-627-2456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FSP HEALTH MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty