Provider Demographics
NPI:1114518412
Name:VALLE, DINA ELENA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:ELENA
Last Name:VALLE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SAN YSIDRO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5414
Mailing Address - Country:US
Mailing Address - Phone:385-401-9912
Mailing Address - Fax:
Practice Address - Street 1:1256 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6026
Practice Address - Country:US
Practice Address - Phone:575-525-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist