Provider Demographics
NPI:1497358964
Name:VALERIO, PABLO JUVENCIO (CNP)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:JUVENCIO
Last Name:VALERIO
Suffix:
Gender:M
Credentials:CNP
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Other - Credentials:
Mailing Address - Street 1:385 CALLE DE ALEGRA STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3423
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:2625 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9608
Practice Address - Country:US
Practice Address - Phone:575-589-0887
Practice Address - Fax:575-589-0898
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1018786363LF0000X
NM64224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93936524Medicaid