Healthcare Provider Details

I. General information

NPI: 1548113657
Provider Name (Legal Business Name): GABRIELLA MARTINEZ-MORENO DN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7516 4TH ST NW
LOS RANCHOS NM
87107-6630
US

IV. Provider business mailing address

1517 31ST ST SE
RIO RANCHO NM
87124-1951
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-9318
  • Fax:
Mailing address:
  • Phone: 505-620-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License NumberDN2025-002
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: