Healthcare Provider Details

I. General information

NPI: 1710820550
Provider Name (Legal Business Name): ALYSHA AILEEN GALLEGOS-YEPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SHEEP SPRINGS CIR
JEMEZ PUEBLO NM
87024-0731
US

IV. Provider business mailing address

110 SHEEP SPRINGS CIR
JEMEZ PUEBLO NM
87024-0731
US

V. Phone/Fax

Practice location:
  • Phone: 575-834-7413
  • Fax: 575-834-9507
Mailing address:
  • Phone: 575-834-7413
  • Fax: 575-834-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: