MEDICARE: DIANA IVETTE VALVERDE CANO

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	363LP0200X	Pediatric Nurse Practitioner	1134089	TX

General Provider Information

NPI Number	:	1316723984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA IVETTE VALVERDE CANO

Provider Business Mailing Address
First Line	:	103 SUENO CT
Second Line	:
City	:	SUNLAND PARK
State	:	NM
Zip	:	88063-9263
Country	:	US
Telephone Number	:	915-329-9272
Fax Number	:

Provider Business Practice Location Address
First Line	:	4321 N MESA ST STE B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1141
Country	:	US
Telephone Number	:	915-996-9700
Fax Number	:

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

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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