Provider Demographics
NPI:1710495288
Name:VALADEZ, ADRIANA X
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:VALADEZ
Suffix:X
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 1:713 N PLAINS PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-3632
Mailing Address - Country:US
Mailing Address - Phone:575-910-1851
Mailing Address - Fax:
Practice Address - Street 1:713 N PLAINS PARK DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-3632
Practice Address - Country:US
Practice Address - Phone:575-910-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM508301715106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3139559086Medicaid
NM106S00000XMedicaid