Provider Demographics
NPI:1386718864
Name:VALENZUELA, ARMANDO (PA)
Entity type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 E CLINTON WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1560
Mailing Address - Country:US
Mailing Address - Phone:559-453-5203
Mailing Address - Fax:559-453-3321
Practice Address - Street 1:255 N HERWALDT DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2186
Practice Address - Country:US
Practice Address - Phone:559-459-7300
Practice Address - Fax:559-459-3750
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17037363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ08098Medicare UPIN