Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 97-170 | NM |
NPI | 1023114170 |
---|---|
Provider Name | Valerie Young |
First Address | Albuquerque, NM 87109-4318 |
Second Address | Albuquerque, NM 87109-4318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 17/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000S7146 | (05) | NM |
G13769 | (02) | NM |