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General NPI Number Information
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NPI Number | 1669744397
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Entity Type | Individual
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Provider Name | BRANDIE PACHECO GALLEGOS
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Gender | Female
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 1101 LOPEZ RD SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-3954
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Country | US
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Telephone | 505-239-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 10031 CORRAL GATE LN SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87121-7257
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Country | US
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Telephone | 505-350-4997
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | NM
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