Healthcare Provider Details

I. General information

NPI: 1356800098
Provider Name (Legal Business Name): VALERIE BANUELOS MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 ANAHEIM AVE NE STE B
ALBUQUERQUE NM
87113-1879
US

IV. Provider business mailing address

2724 VIOLETA CIR SE
RIO RANCHO NM
87124-2599
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-4618
  • Fax: 505-922-4917
Mailing address:
  • Phone: 562-395-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: