MEDICARE: MRS. AMY M VALDEZ RD

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	133V00000X	Registered Dietitian	860-920-86	CA

General Provider Information

NPI Number	:	1548833114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY M VALDEZ RD

Provider Business Mailing Address
First Line	:	501 S PUTTER DR
Second Line	:
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1822
Country	:	US
Telephone Number	:	562-774-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S PUTTER DR
Second Line	:
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1822
Country	:	US
Telephone Number	:	562-774-8944
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	12/01/2025

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