Healthcare Provider Details

I. General information

NPI: 1598308801
Provider Name (Legal Business Name): VALENCIA HEALTH AND WELLNESS, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 6TH ST
BELEN NM
87002-3605
US

IV. Provider business mailing address

101 N 6TH ST
BELEN NM
87002-3605
US

V. Phone/Fax

Practice location:
  • Phone: 505-317-7773
  • Fax: 855-844-8611
Mailing address:
  • Phone: 505-317-7773
  • Fax: 855-844-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER TAFOYA TRUJILLO
Title or Position: OWNER
Credential: PA-C
Phone: 505-249-4456