Healthcare Provider Details

I. General information

NPI: 1578787834
Provider Name (Legal Business Name): CHRISTY JO VALDEZ CNMT, LMT, CKT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY JO RODGERS CNMT,LMT,CKT

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSUNA RD NE STE 700
ALBUQUERQUE NM
87113-0009
US

IV. Provider business mailing address

PO BOX 95594
ALBUQUERQUE NM
87199-5594
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-4325
  • Fax:
Mailing address:
  • Phone: 505-235-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3703
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: