Healthcare Provider Details

I. General information

NPI: 1255172383
Provider Name (Legal Business Name): CYNTHIA MARIE VALENZUELA RVT,RVS,RCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N ROADRUNNER PKWY STE 137
LAS CRUCES NM
88011-2001
US

IV. Provider business mailing address

1431 VISTA DEL CERRO
LAS CRUCES NM
88007-8906
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5511
  • Fax: 575-522-0825
Mailing address:
  • Phone: 575-640-7393
  • Fax: 575-522-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberVS00478
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: