Basic Information
Provider Information
NPI: 1750846606
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOYD
FirstName: LESLIE
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5816 ACADEMY CT NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871093877
CountryCode: US
TelephoneNumber: 5054402179
FaxNumber:  
Practice Location
Address1: 6565 AMERICAS PKWY NE STE 200
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871108172
CountryCode: US
TelephoneNumber: 8662732451
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/05/2019
LastUpdateDate: 02/05/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


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