Healthcare Provider Details

I. General information

NPI: 1851409577
Provider Name (Legal Business Name): GALISTEO OB/GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST SUITE D
SANTA FE NM
87505-4780
US

IV. Provider business mailing address

1691 GALISTEO ST SUITE D
SANTA FE NM
87505-4780
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-3290
  • Fax:
Mailing address:
  • Phone: 505-992-3290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER RONKOS
Title or Position: CONSULTANT
Credential:
Phone: 505-992-3290