1871688184 NPI number — DEL VALLE PHYSICAL THERAPY AND REHABILITATION

Table of content: (NPI 1871688184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871688184 NPI number — DEL VALLE PHYSICAL THERAPY AND REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEL VALLE PHYSICAL THERAPY AND REHABILITATION
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:
1871688184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2445 MISSOURI AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88001-5111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-523-8080
Provider Business Mailing Address Fax Number:
505-523-8861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2445 MISSOURI AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-5111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-523-8080
Provider Business Practice Location Address Fax Number:
575-523-8861
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FIGUEROA
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
575-523-8080

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1724 . This is a "LOVELACE HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 53226003 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM00NA65 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 10524 . This is a "PRESBYTERIAN HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: PROVA41159 . This is a "MOLINA HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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