Healthcare Provider Details

I. General information

NPI: 1023903317
Provider Name (Legal Business Name): REBECCA ANDREA GABALDON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANDREA CORDOVA RN

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

85 SQUARE DEAL RD
BELEN NM
87002-6371
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1894
  • Fax:
Mailing address:
  • Phone: 505-903-1301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number82427
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: