Healthcare Provider Details

I. General information

NPI: 1508011487
Provider Name (Legal Business Name): MARILYN VALVERDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 MONTANO RD NW STE A
ALBUQUERQUE NM
87120-2170
US

IV. Provider business mailing address

6116 BLACK RIDGE DR NW
ALBUQUERQUE NM
87120-2184
US

V. Phone/Fax

Practice location:
  • Phone: 505-495-9454
  • Fax:
Mailing address:
  • Phone: 505-459-4954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7756
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: