MEDICARE: JULIA AMANDA VALDEZ-ALBERTSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		CO

General Provider Information

NPI Number	:	1871373696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA AMANDA VALDEZ-ALBERTSON

Provider Business Mailing Address
First Line	:	2290 MCDANIEL ST STE 1B
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6330
Country	:	US
Telephone Number	:	702-899-1924
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 MCDANIEL ST STE 1B
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6330
Country	:	US
Telephone Number	:	702-899-1924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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