Healthcare Provider Details

I. General information

NPI: 1629992995
Provider Name (Legal Business Name): DAVID C VALENCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2069 MULLINS AVENUE #109
ALAMOSA CO
81101
US

IV. Provider business mailing address

2069 MULLINS AVENUE 109
ALAMOSA CO
81101
US

V. Phone/Fax

Practice location:
  • Phone: 909-527-0142
  • Fax:
Mailing address:
  • Phone: 909-527-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-514888
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: