Healthcare Provider Details

I. General information

NPI: 1255114732
Provider Name (Legal Business Name): JULIA VICTORIA MALAVE EIGENMANN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1194
CLOUDCROFT NM
88317-1194
US

IV. Provider business mailing address

PO BOX 1194
CLOUDCROFT NM
88317-1194
US

V. Phone/Fax

Practice location:
  • Phone: 575-682-1014
  • Fax: 877-471-7599
Mailing address:
  • Phone: 575-682-1014
  • Fax: 877-471-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75201
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: