Healthcare Provider Details

I. General information

NPI: 1750080032
Provider Name (Legal Business Name): TINA MARIE VALORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MONROE ST NE
ALBUQUERQUE NM
87110-6368
US

IV. Provider business mailing address

605 MONROE ST NE
ALBUQUERQUE NM
87110-6368
US

V. Phone/Fax

Practice location:
  • Phone: 505-999-8345
  • Fax: 505-212-3287
Mailing address:
  • Phone: 505-999-8345
  • Fax: 505-212-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberT23001
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: