Provider Demographics
NPI:1609393636
Name:VALENCIA-VARELA, GRACIELLA LILIANA
Entity Type:Individual
Prefix:
First Name:GRACIELLA
Middle Name:LILIANA
Last Name:VALENCIA-VARELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#03 WEST CHAMISA SPUR
Mailing Address - Street 2:03
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552
Mailing Address - Country:US
Mailing Address - Phone:505-490-2598
Mailing Address - Fax:
Practice Address - Street 1:#03 WEST CHAMISA SPUR
Practice Address - Street 2:03
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552
Practice Address - Country:US
Practice Address - Phone:505-490-2598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician