Healthcare Provider Details

I. General information

NPI: 1033894506
Provider Name (Legal Business Name): LESLY VELAZQUEZ ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 GRANDE BLVD SE STE 102
RIO RANCHO NM
87124-1751
US

IV. Provider business mailing address

2240 GRANDE BLVD SE STE 102
RIO RANCHO NM
87124-1751
US

V. Phone/Fax

Practice location:
  • Phone: 505-218-7321
  • Fax:
Mailing address:
  • Phone: 505-218-7321
  • Fax: 866-608-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: