Healthcare Provider Details

I. General information

NPI: 1679803761
Provider Name (Legal Business Name): VALARI JEAN TAYLOR R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 IRVING BLVD NW
ALBUQUERQUE NM
87114-5915
US

IV. Provider business mailing address

1121 STONEY CREEK BLVD
LAKELAND FL
33811-2328
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-2790
  • Fax:
Mailing address:
  • Phone: 863-646-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD0983
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: