Healthcare Provider Details

I. General information

NPI: 1619510815
Provider Name (Legal Business Name): ERIKA J VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N GRAND AVE
PUEBLO CO
81003-3111
US

IV. Provider business mailing address

415 N GRAND AVE
PUEBLO CO
81003-3111
US

V. Phone/Fax

Practice location:
  • Phone: 719-924-8448
  • Fax: 719-924-9382
Mailing address:
  • Phone: 719-924-8448
  • Fax: 719-924-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995122-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: