Healthcare Provider Details

I. General information

NPI: 1760612568
Provider Name (Legal Business Name): REFORM SPINE & INJURY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSUNA RD NE SUITE 700
ALBUQUERQUE NM
87113-1384
US

IV. Provider business mailing address

701 OSUNA RD. NE SUITE 700
ALBUQUERQUE NM
87113
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-4325
  • Fax: 505-822-8460
Mailing address:
  • Phone: 505-821-4325
  • Fax: 505-822-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR35692
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5384
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5075
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number3703
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD2006-0083
License Number StateNM

VIII. Authorized Official

Name: MRS. CHRISTY J VALDEZ
Title or Position: PRESIDENT/CEO
Credential: CNMT, LMT
Phone: 505-821-4325