Basic Information
| Provider Information | |||||||||
| NPI: | 1033306220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALENZUELA | ||||||||
| FirstName: | GLENN GERARD | ||||||||
| MiddleName: | ABANO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 CAMINO RAMON | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945834385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9255430140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 NE MULTNOMAH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038133860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A93968 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.