Healthcare Provider Details

I. General information

NPI: 1669056610
Provider Name (Legal Business Name): VALER 120 EUBANK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EUBANK BLVD SE
ALBUQUERQUE NM
87123-3399
US

IV. Provider business mailing address

120 EUBANK BLVD SE
ALBUQUERQUE NM
87123-3399
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-2000
  • Fax:
Mailing address:
  • Phone: 505-588-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARSHALL KING
Title or Position: HR & FINANCE DIRECTOR
Credential:
Phone: 505-263-8690