Healthcare Provider Details

I. General information

NPI: 1487627246
Provider Name (Legal Business Name): DAVID M. VALENZUELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 S TELSHOR BLVD
LAS CRUCES NM
88011-5049
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5678
  • Fax: 575-522-1609
Mailing address:
  • Phone: 575-532-7000
  • Fax: 575-532-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77-282
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: