Healthcare Provider Details

I. General information

NPI: 1134515737
Provider Name (Legal Business Name): AMANDA S VALONE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE RM 145
ALBUQUERQUE NM
87108-5180
US

IV. Provider business mailing address

1616 CAMINO REDONDO
LOS ALAMOS NM
87544-2719
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-7657
  • Fax:
Mailing address:
  • Phone: 505-661-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA-2117-18
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: