Healthcare Provider Details

I. General information

NPI: 1285200329
Provider Name (Legal Business Name): AURORA DEL VALLE MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 05/30/2021
Certification Date: 05/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RODEO RD
SANTA FE NM
87505-6378
US

IV. Provider business mailing address

4000 LA CARRERA APT 1121
SANTA FE NM
87507-4059
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-5894
  • Fax:
Mailing address:
  • Phone: 505-920-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8091
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: