Provider Demographics
NPI:1144426735
Name:ARNOLD W. VALDIVIA, M.D., P.C.
Entity Type:Organization
Organization Name:ARNOLD W. VALDIVIA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:W
Authorized Official - Last Name:VALDIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-287-4474
Mailing Address - Street 1:1208 BONITA ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-2234
Mailing Address - Country:US
Mailing Address - Phone:505-287-4474
Mailing Address - Fax:505-287-8775
Practice Address - Street 1:1208 BONITA ST
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2234
Practice Address - Country:US
Practice Address - Phone:505-287-4474
Practice Address - Fax:505-287-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87-355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM525130174Medicare PIN