Healthcare Provider Details

I. General information

NPI: 1780650986
Provider Name (Legal Business Name): LORENE S VALDEZ-BOYLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL, NE SUITE C1 UNMHSC SPECIALTY EXTENSION SERVICES
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

801 ENCINO PL, NE SUITE C1 UNMHSC SPECIALTY EXTENSION SERVICES
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-0110
  • Fax: 505-272-2360
Mailing address:
  • Phone: 505-272-0110
  • Fax: 505-272-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20050754
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number20050754
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: