Healthcare Provider Details

I. General information

NPI: 1215078167
Provider Name (Legal Business Name): JEANINE LOUISE VALDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 RIVERSIDE PLAZA LN NW STE A
ALBUQUERQUE NM
87120-1710
US

IV. Provider business mailing address

6320 RIVERSIDE PLAZA LN NW STE B
ALBUQUERQUE NM
87120-1710
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-6168
  • Fax: 505-792-1978
Mailing address:
  • Phone: 505-843-6168
  • Fax: 505-792-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2006-0379
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: