Healthcare Provider Details

I. General information

NPI: 1003752866
Provider Name (Legal Business Name): MATTHEW JUDE GALATAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 JACK RABBIT RUN
TIJERAS NM
87059-7325
US

IV. Provider business mailing address

31 JACK RABBIT RUN
TIJERAS NM
87059-7325
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-5945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number83189
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: