Healthcare Provider Details

I. General information

NPI: 1851908305
Provider Name (Legal Business Name): VALENTINA ABIGAIL MACIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SAN PEDRO DR NE
ALBUQUERQUE NM
87110-4133
US

IV. Provider business mailing address

2 FUENTE RD
LOS LUNAS NM
87031-5875
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 505-910-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: