MEDICARE: DEREK VALDEZ

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	225100000X	Physical Therapist	PT5866	NM

General Provider Information

NPI Number	:	1578420485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK VALDEZ

Provider Business Mailing Address
First Line	:	3304 SIRINGO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5053
Country	:	US
Telephone Number	:	505-795-2631
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 SIRINGO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5053
Country	:	US
Telephone Number	:	505-795-2631
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ DEREK VALDEZ ” Practice Location

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