Provider Demographics
NPI:1730263484
Name:VALENZUELA, GUILLERMO J (MD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:J
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1762
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0857
Mailing Address - Country:US
Mailing Address - Phone:909-580-6332
Mailing Address - Fax:909-580-3289
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:MOB 206
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-6333
Practice Address - Fax:909-580-3289
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA38671207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28695Medicare UPIN