Healthcare Provider Details

I. General information

NPI: 1043160633
Provider Name (Legal Business Name): KALEY VICTORIA MISQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E HADLEY AVE
LAS CRUCES NM
88001-2615
US

IV. Provider business mailing address

4360 NM-15
SILVER CITY NM
88061
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-3775
  • Fax:
Mailing address:
  • Phone: 201-477-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: