Healthcare Provider Details

I. General information

NPI: 1720983729
Provider Name (Legal Business Name): BRIANNA J GALLEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE STE 105
ALBUQUERQUE NM
87109-2100
US

IV. Provider business mailing address

2912 TENNESSEE ST NE
ALBUQUERQUE NM
87110-3710
US

V. Phone/Fax

Practice location:
  • Phone: 505-314-1444
  • Fax:
Mailing address:
  • Phone: 505-269-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1063418960
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: