Healthcare Provider Details

I. General information

NPI: 1023255510
Provider Name (Legal Business Name): VALENCIA FAMILY MEDICINE & EXPRESS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S. LOS LENTES
LOS LUNAS NM
87031
US

IV. Provider business mailing address

311 S. LOS LENTES
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-2232
  • Fax: 505-565-2272
Mailing address:
  • Phone: 505-565-2232
  • Fax: 505-565-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR35144
License Number StateNM

VIII. Authorized Official

Name: MS. LEONA MARIE HERRELL
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-C
Phone: 505-565-2232