Provider Demographics
NPI:1528556024
Name:VALDEZ, EUSEBIO VICTOR
Entity Type:Individual
Prefix:
First Name:EUSEBIO
Middle Name:VICTOR
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 W APACHE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5527
Mailing Address - Country:US
Mailing Address - Phone:505-592-0623
Mailing Address - Fax:505-326-3085
Practice Address - Street 1:406 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5518
Practice Address - Country:US
Practice Address - Phone:505-326-5358
Practice Address - Fax:505-326-3085
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator