Healthcare Provider Details

I. General information

NPI: 1497022032
Provider Name (Legal Business Name): PAT VELARDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 AIRPORT DR STE 260
FARMINGTON NM
87401-2401
US

IV. Provider business mailing address

501 AIRPORT DR STE 260
FARMINGTON NM
87401-2401
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-0293
  • Fax: 505-564-4925
Mailing address:
  • Phone: 505-327-0293
  • Fax: 505-564-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4308
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: