Individual
MARIO RL VALENZUELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Mailing address
2901 HUNTERS TRL, PO BOX 301, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
41231020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32603500
—
WI
Enumeration date
09/13/2006
Last updated
04/15/2014
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