Provider Demographics
NPI:1942030366
Name:VALENZUELA, JAIME ENRIQUE (LVN)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ENRIQUE
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-2347
Mailing Address - Country:US
Mailing Address - Phone:361-851-6900
Mailing Address - Fax:361-806-5642
Practice Address - Street 1:925 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-2347
Practice Address - Country:US
Practice Address - Phone:361-851-6900
Practice Address - Fax:361-806-5642
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170525164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse