Provider Demographics
NPI:1275507790
Name:ROMERO-LEGGOTT, VALERIE L (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:L
Last Name:ROMERO-LEGGOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 NORTH CENTRO FAMILIAR SW
Mailing Address - Street 2:
Mailing Address - City:ALB
Mailing Address - State:NM
Mailing Address - Zip Code:87105
Mailing Address - Country:US
Mailing Address - Phone:505-873-7462
Mailing Address - Fax:
Practice Address - Street 1:2300 ARENAL SW
Practice Address - Street 2:
Practice Address - City:ALB
Practice Address - State:NM
Practice Address - Zip Code:87105
Practice Address - Country:US
Practice Address - Phone:505-873-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ6074Medicaid
NMZ6074Medicaid