Healthcare Provider Details

I. General information

NPI: 1447643895
Provider Name (Legal Business Name): VALOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 ROSINA ST STE #6
SANTA FE NM
87505-3271
US

IV. Provider business mailing address

24B WINDSPIRIT RD
SANTA FE NM
87505-1442
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-5756
  • Fax:
Mailing address:
  • Phone: 505-466-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: FLAVIO SALAZAR
Title or Position: OWNER
Credential: LISW
Phone: 505-466-2747