Healthcare Provider Details

I. General information

NPI: 1124969902
Provider Name (Legal Business Name): VALLEY COMMUNITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 LA MIRADA PL NE
ALBUQUERQUE NM
87109-1605
US

IV. Provider business mailing address

8120 LA MIRADA PL NE
ALBUQUERQUE NM
87109-1605
US

V. Phone/Fax

Practice location:
  • Phone: 505-221-6337
  • Fax:
Mailing address:
  • Phone: 505-221-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EMILY COHEN
Title or Position: MD
Credential:
Phone: 505-221-6337