Healthcare Provider Details

I. General information

NPI: 1114518412
Provider Name (Legal Business Name): DINA ELENA VALLE PHARM.D, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 EL PASEO RD
LAS CRUCES NM
88001-6026
US

IV. Provider business mailing address

4100 SAN YSIDRO RD
LAS CRUCES NM
88007-5414
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-8713
  • Fax:
Mailing address:
  • Phone: 385-401-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009437
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: