Provider Demographics
NPI:1699776492
Name:VALENZUELA, ROBERT T (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5400 GIBSON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4729
Mailing Address - Country:US
Mailing Address - Phone:505-262-7960
Mailing Address - Fax:505-232-1368
Practice Address - Street 1:500 WALTER ST NE STE 401
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2563
Practice Address - Country:US
Practice Address - Phone:505-262-3542
Practice Address - Fax:505-262-7394
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0002207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4236826Medicaid
MI127814OtherPREF CHOICE BILLING
MI383552631054OtherCOMMUNITY CHOICE BILLING
MI4236826OtherMOLINA BILLING NUMBER
MI110H310180OtherBLUE CROSS BILLING
MI27544OtherPRIORITY HEALTH BILLING
MIG49876Medicare UPIN
MI0N17550003Medicare PIN
NMNM301572Medicare PIN