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General NPI Number Information
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NPI Number | 1215331681
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Entity Type | Individual
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Provider Name | ADRIAN VALLEJOS
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Gender | Male
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 2620 SAN MATEO BLVD NE STE F
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3163
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Country | US
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Telephone | 505-888-4044
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 SPANISH BIT NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-4263
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Country | US
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Telephone | 505-431-1419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 6928
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License Number State | NM
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