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General NPI Number Information
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NPI Number | 1760735591
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Entity Type | Organization
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Legal Business Name | VALENCIA VALLEY HEALTHCARE INC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 111 ISLETA BLVD SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-3896
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Country | US
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Telephone | 505-200-2647
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3439
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City | LOS LUNAS
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State | NM
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Zip | 87031-3439
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Country | US
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Telephone | 505-200-2647
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Fax |
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Authorized Official
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Title or Position | PARTNER/CFNP
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Name | JOSE ROLANDO FLORES
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Credential |
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Telephone | 505-200-2647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R37352
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License Number State | NM
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