Provider Demographics
NPI:1326290123
Name:VALENZUELA, ROXANA J (LMT)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:J
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2593 DESERT WIND WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-8346
Mailing Address - Country:US
Mailing Address - Phone:575-635-3530
Mailing Address - Fax:
Practice Address - Street 1:3961 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8269
Practice Address - Country:US
Practice Address - Phone:575-525-9960
Practice Address - Fax:575-525-9958
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6070172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist