Healthcare Provider Details

I. General information

NPI: 1316931769
Provider Name (Legal Business Name): CHRISTINA M GALOS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511A HWY 314 SW
LOS LUNAS NM
87031-9600
US

IV. Provider business mailing address

511A HWY 314 SW
LOS LUNAS NM
87031-9600
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-3937
  • Fax: 505-565-3900
Mailing address:
  • Phone: 505-565-3937
  • Fax: 505-565-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number495
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: