Basic Information
| Provider Information | |||||||||
| NPI: | 1588860381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAEL | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26028 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052627915 | ||||||||
| FaxNumber: | 5052321627 | ||||||||
| Practice Location | |||||||||
| Address1: | 10511 GOLF COURSE RD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871145916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052627281 | ||||||||
| FaxNumber: | 5052627622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | RS2007-0352 | NM | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD2012-0648 | NM | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | NMA102892 | 01 | NM | MEDICARE | OTHER | 27404820 | 05 | NM | MEDICAID | RS2007-0352 | 01 | NM | TRAINING LICENCE | OTHER |