Healthcare Provider Details

I. General information

NPI: 1215435755
Provider Name (Legal Business Name): AMBER NICOLE VELEZ CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 SAKELARES BLVD
GRANTS NM
87020-3819
US

IV. Provider business mailing address

3506 CAMINO DE LOS CABALLOS
GALLUP NM
87301-6892
US

V. Phone/Fax

Practice location:
  • Phone: 505-876-1890
  • Fax:
Mailing address:
  • Phone: 505-862-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: