Healthcare Provider Details

I. General information

NPI: 1942763263
Provider Name (Legal Business Name): KRISTIN ALYSSA GIACOLONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE STE 19400
RIO RANCHO NM
87124-3392
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-6100
  • Fax: 605-253-6179
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2025-0764
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: