Provider Demographics
NPI:1174785232
Name:BOULOM, VALY (MD)
Entity type:Individual
Prefix:DR
First Name:VALY
Middle Name:
Last Name:BOULOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18525 SUTTER BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2883
Mailing Address - Country:US
Mailing Address - Phone:408-333-9580
Mailing Address - Fax:408-663-5222
Practice Address - Street 1:18525 SUTTER BLVD STE 140
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2883
Practice Address - Country:US
Practice Address - Phone:408-333-9580
Practice Address - Fax:408-663-5222
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1300202086S0129X
MDP22886208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery