Healthcare Provider Details

I. General information

NPI: 1740097054
Provider Name (Legal Business Name): PAULINE VALENZUELA CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N CALIFORNIA ST
SOCORRO NM
87801-4207
US

IV. Provider business mailing address

PO BOX 660
SOCORRO NM
87801-0660
US

V. Phone/Fax

Practice location:
  • Phone: 575-838-0061
  • Fax: 575-838-0786
Mailing address:
  • Phone: 575-838-0061
  • Fax: 575-838-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: