Healthcare Provider Details

I. General information

NPI: 1427342864
Provider Name (Legal Business Name): ADRIANNA CHRISTINE GALLEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 GAUDIAN LOOP
SANDIA PARK NM
87047-9555
US

IV. Provider business mailing address

9 GAUDIAN LOOP
SANDIA PARK NM
87047-9555
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-2119
  • Fax: 505-445-4504
Mailing address:
  • Phone: 505-620-2119
  • Fax: 505-445-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09917
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: