Healthcare Provider Details

I. General information

NPI: 1710557202
Provider Name (Legal Business Name): ANIMAS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 ROAD 3000
AZTEC NM
87410-9501
US

IV. Provider business mailing address

407 SOLANO DR NE
ALBUQUERQUE NM
87108-1045
US

V. Phone/Fax

Practice location:
  • Phone: 505-592-2429
  • Fax:
Mailing address:
  • Phone: 505-592-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOPAUL VALLES
Title or Position: SOLE MEMBER
Credential: CNP
Phone: 505-592-2429