Basic Information
| Provider Information | |||||||||
| NPI: | 1780650986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALDEZ-BOYLE | ||||||||
| FirstName: | LORENE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 ENCINO PL, NE SUITE C1 | ||||||||
| Address2: | UNMHSC SPECIALTY EXTENSION SERVICES | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052720110 | ||||||||
| FaxNumber: | 5052722360 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 ENCINO PL, NE SUITE C1 | ||||||||
| Address2: | UNMHSC SPECIALTY EXTENSION SERVICES | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052720110 | ||||||||
| FaxNumber: | 5052722360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 09/06/2012 | ||||||||
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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 | 20050754 | NM | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 20050754 | NM | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.