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General NPI Number Information
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NPI Number | 1528352457
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Entity Type | Organization
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Legal Business Name | CLINICA DEL VALLE LLC
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 1720 BRIDGE BLVD SW STE F
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-3100
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Country | US
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Telephone | 505-508-5398
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Fax | 505-508-5374
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Provider Business Mailing Address
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Address Line | 1720 BRIDGE BLVD SW STE F
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-3100
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Country | US
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Telephone | 505-508-5398
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Fax | 505-508-5374
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE TRUJILLO
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Credential | CNP
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Telephone | 505-508-5398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP01205
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License Number State | NM
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