Provider Demographics
NPI:1902790777
Name:VALDIVIA, NAOMI
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:VALDIVIA
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 1:7012 RAASAF DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-4621
Mailing Address - Country:US
Mailing Address - Phone:214-995-3734
Mailing Address - Fax:575-267-6228
Practice Address - Street 1:715 E IDAHO AVE STE 3E
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4702
Practice Address - Country:US
Practice Address - Phone:575-323-8900
Practice Address - Fax:575-267-6228
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM05022025172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker