Healthcare Provider Details

I. General information

NPI: 1548767296
Provider Name (Legal Business Name): CYNTHIA C VALDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 SOUTH 6TH STREET
LOVING NM
88256
US

IV. Provider business mailing address

PO BOX 98
LOVING NM
88256-0098
US

V. Phone/Fax

Practice location:
  • Phone: 575-745-2077
  • Fax: 575-745-2072
Mailing address:
  • Phone: 575-745-2077
  • Fax: 575-745-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-69757
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: