Healthcare Provider Details

I. General information

NPI: 1972304921
Provider Name (Legal Business Name): ENGELBERT GUANLAO VALENCIA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LOMA COLORADO BLVD NE
RIO RANCHO NM
87124-6524
US

IV. Provider business mailing address

6923 TRAPPER CREEK RD NE
RIO RANCHO NM
87144-5660
US

V. Phone/Fax

Practice location:
  • Phone: 505-962-5063
  • Fax:
Mailing address:
  • Phone: 850-291-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1019
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: