Healthcare Provider Details

I. General information

NPI: 1467051490
Provider Name (Legal Business Name): MARILYN JOSEPHINE VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001-B EL CENTRO FAMILIAR SE
ALBUQUERQUE NM
87106-4374
US

IV. Provider business mailing address

933 BRADBURY DR. NE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5786
  • Fax:
Mailing address:
  • Phone: 505-220-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: