1023255510 NPI number — VALENCIA FAMILY MEDICINE & EXPRESS CARE

Table of content: (NPI 1023255510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023255510 NPI number — VALENCIA FAMILY MEDICINE & EXPRESS CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALENCIA FAMILY MEDICINE & EXPRESS CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023255510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 S. LOS LENTES
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS LUNAS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-565-2232
Provider Business Mailing Address Fax Number:
505-565-2272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 S. LOS LENTES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS LUNAS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-565-2232
Provider Business Practice Location Address Fax Number:
505-565-2272
Provider Enumeration Date:
01/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HERRELL
Authorized Official First Name:
LEONA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
505-565-2232

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  R35144 , 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)

  • Identifier: PENDING . This is a "NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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