MEDICARE: MS. VALERIE RIVERA MARTINEZ

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1629302724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE RIVERA MARTINEZ

Provider Business Mailing Address
First Line	:	904 E FAIRVIEW DRIVE
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532
Country	:	US
Telephone Number	:	505-747-1991
Fax Number	:	505-753-6462

Provider Business Practice Location Address
First Line	:	904 E FAIRVIEW LN
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2822
Country	:	US
Telephone Number	:	505-747-1991
Fax Number	:	505-753-6462

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

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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Directions to “ MS. VALERIE RIVERA MARTINEZ ” Practice Location

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