Healthcare Provider Details

I. General information

NPI: 1053221614
Provider Name (Legal Business Name): RAQUEL GALLUCCI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 JACKIE RD SE STE 104
RIO RANCHO NM
87124-1519
US

IV. Provider business mailing address

PO BOX 15782
RIO RANCHO NM
87174-0782
US

V. Phone/Fax

Practice location:
  • Phone: 505-515-3981
  • Fax:
Mailing address:
  • Phone: 505-515-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number91390
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: