Individual
REBECCA JANE WALLIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1010 SPRUCE ST, ESPANOLA, NM 87532-2724
(505) 367-0340
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
DO2024-0091
NM
Other
Enumeration date
04/22/2021
Last updated
07/16/2024
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