Healthcare Provider Details

I. General information

NPI: 1710684022
Provider Name (Legal Business Name): KHRISI MARIE VALDEZ OROFACIAL MYOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S ONEIDA ST
DENVER CO
80224-2549
US

IV. Provider business mailing address

2121 S ONEIDA ST
DENVER CO
80224-2549
US

V. Phone/Fax

Practice location:
  • Phone: 303-759-2760
  • Fax:
Mailing address:
  • Phone: 303-759-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number1245788
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number124577
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number124577
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number124578
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: