Provider Demographics
NPI:1699705822
Name:VALENZUELA, EFREN SISON (MD)
Entity type:Individual
Prefix:MR
First Name:EFREN
Middle Name:SISON
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1704 W MANCHESTER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3034
Mailing Address - Country:US
Mailing Address - Phone:323-778-6215
Mailing Address - Fax:323-778-6312
Practice Address - Street 1:1704 W MANCHESTER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3034
Practice Address - Country:US
Practice Address - Phone:323-778-6215
Practice Address - Fax:323-778-6312
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA40381208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A403810Medicaid