Provider Demographics
NPI:1851908305
Name:MACIAS, VALENTINA ABIGAIL
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:ABIGAIL
Last Name:MACIAS
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 1:2 FUENTE RD
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-5875
Mailing Address - Country:US
Mailing Address - Phone:505-910-7634
Mailing Address - Fax:
Practice Address - Street 1:2 FUENTE RD
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-5875
Practice Address - Country:US
Practice Address - Phone:505-910-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician