Individual
MR. JOSE LUIS VALDIVIEZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
100 W GRIGGS AVE, LAS CRUCES, NM 88001-1234
(575) 647-2800
(575) 647-2898
Mailing address
385 CALLE DE ALEGRA STE A, LAS CRUCES, NM 88005-3423
(575) 526-1105
(575) 524-4266
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-08667
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15030709
—
NM
01
—
364063YRND
MEDICARE
NM
Enumeration date
08/20/2009
Last updated
08/30/2018
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