MEDICARE: TAYLIA CELESTE VALLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		NM

General Provider Information

NPI Number	:	1104771039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLIA CELESTE VALLO

Provider Business Mailing Address
First Line	:	18 BLUE SKY TRAIL
Second Line	:	P.O BOX 239
City	:	ACOMA
State	:	NM
Zip	:	87034
Country	:	US
Telephone Number	:	505-272-5935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 MARBLE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2058
Country	:	US
Telephone Number	:	505-272-5935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “ TAYLIA CELESTE VALLO ” Practice Location

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