Provider Demographics
NPI:1467561118
Name:VALDIVIA, ARNOLD W (MD)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:W
Last Name:VALDIVIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM012384OtherBCBS
NM201010242OtherPRESBYTERIAN HEALTH CARE
NM20628Medicaid
NMNM300366Medicare PIN
NM201010242OtherPRESBYTERIAN HEALTH CARE
NM20628Medicaid