Healthcare Provider Details

I. General information

NPI: 1073456406
Provider Name (Legal Business Name): JULIANA VICTORIA VIDAL SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 N TELSHOR BLVD
LAS CRUCES NM
88011-8223
US

IV. Provider business mailing address

7849 TRAMWAY BLVD NE STE A
ALBUQUERQUE NM
87122-2529
US

V. Phone/Fax

Practice location:
  • Phone: 575-515-0101
  • Fax: 505-334-1999
Mailing address:
  • Phone: 505-895-9381
  • Fax: 505-213-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2026-0057
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: