Provider Demographics
NPI:1235988288
Name:VALDEZ, AYLIN GUADALUPE
Entity type:Individual
Prefix:
First Name:AYLIN
Middle Name:GUADALUPE
Last Name:VALDEZ
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 1:7980 HIGHWAY 478
Mailing Address - Street 2:
Mailing Address - City:VADO
Mailing Address - State:NM
Mailing Address - Zip Code:88072-7224
Mailing Address - Country:US
Mailing Address - Phone:575-449-1676
Mailing Address - Fax:
Practice Address - Street 1:6401 S RICHARDS AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-4887
Practice Address - Country:US
Practice Address - Phone:505-982-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2024-0132124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist