1740277953 NPI number — DR. VALERIE ECKLUND TALENTO DOM

Table of content: DR. VALERIE ECKLUND TALENTO DOM (NPI 1740277953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740277953 NPI number — DR. VALERIE ECKLUND TALENTO DOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALENTO
Provider First Name:
VALERIE
Provider Middle Name:
ECKLUND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ECKLUND
Provider Other First Name:
ANNE
Provider Other Middle Name:
VALERIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DOM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1740277953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711-A ENCINO PL NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87102-2652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-243-8058
Provider Business Mailing Address Fax Number:
505-243-8057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711-A ENCINO PL NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-243-8058
Provider Business Practice Location Address Fax Number:
505-243-8057
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  82 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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