Healthcare Provider Details

I. General information

NPI: 1225723380
Provider Name (Legal Business Name): SELENA MARIE GALLEGOS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MALL DR
LAS CRUCES NM
88011-8128
US

IV. Provider business mailing address

MSC09 5040 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-3270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRS2023-1175
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: