Healthcare Provider Details

I. General information

NPI: 1346762192
Provider Name (Legal Business Name): CRISTAL MARTINEZ VALDEZ MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 LA JOYA STREET
ESPANOLA NM
87532-2877
US

IV. Provider business mailing address

PO BOX 1106
SANTA CRUZ NM
87567-1106
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-6550
  • Fax: 505-753-1219
Mailing address:
  • Phone: 505-927-1045
  • Fax: 505-753-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3628
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: