Provider Demographics
NPI:1407412273
Name:VALENCIA, VICTORIA (LMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VALENCIA
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 1:10900 TANZANITE DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1853
Mailing Address - Country:US
Mailing Address - Phone:505-239-9644
Mailing Address - Fax:505-896-2958
Practice Address - Street 1:1005 21ST ST SE STE 9
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4030
Practice Address - Country:US
Practice Address - Phone:505-239-9644
Practice Address - Fax:505-896-2958
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8287OtherLMT