Healthcare Provider Details

I. General information

NPI: 1750200101
Provider Name (Legal Business Name): DOMINIC REX VALDES MUMMA NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 KALLOF PL
SEDONA AZ
86336-5566
US

IV. Provider business mailing address

125 KALLOF PL
SEDONA AZ
86336-5566
US

V. Phone/Fax

Practice location:
  • Phone: 928-239-4589
  • Fax: 928-204-2128
Mailing address:
  • Phone: 928-239-4589
  • Fax: 928-204-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number26-4044
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: