Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | TX575 | TX |
Y | 222Z00000X | Podiatrist | TX575 | TX |
NPI | 1063514362 |
---|---|
Provider Name | J Michael Valenza |
First Address | Austin, TX 78746-5248 |
Second Address | Austin, TX 78746-5248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 19/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AP45 | GROUP PTAN (01) | TX |
838463 | PROVIDER # (01) | TX |
T16384 | (02) |