Healthcare Provider Details

I. General information

NPI: 1972497030
Provider Name (Legal Business Name): SIBONEY RODRIGUEZ-GALLEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 PALERMO CT NE
RIO RANCHO NM
87144-5438
US

IV. Provider business mailing address

3209 PALERMO CT NE
RIO RANCHO NM
87144-5438
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-2828
  • Fax:
Mailing address:
  • Phone: 505-620-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number326212
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: