Provider Demographics
NPI:1912568577
Name:BULNES VIDES, RENE ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:ALEJANDRO
Last Name:BULNES VIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 HARPER DR NE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3569
Mailing Address - Country:US
Mailing Address - Phone:505-848-3730
Mailing Address - Fax:505-848-3732
Practice Address - Street 1:5901 HARPER DR NE BLDG 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3569
Practice Address - Country:US
Practice Address - Phone:505-848-3730
Practice Address - Fax:505-848-3732
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2025-0490174400000X, 207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist