Healthcare Provider Details

I. General information

NPI: 1477209575
Provider Name (Legal Business Name): DR. CARL VALDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8016 MONTE CARLO DR NW
ALBUQUERQUE NM
87120-3287
US

IV. Provider business mailing address

8016 MONTE CARLO DR NW
ALBUQUERQUE NM
87120-3287
US

V. Phone/Fax

Practice location:
  • Phone: 505-453-7110
  • Fax:
Mailing address:
  • Phone: 505-453-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number224555
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: