Organization
ESPES EST,LLC
Active
Other names
GALLUP NEUROLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FLOR JARASA CABALLAR GONZAGA M.D. (ORGANIZER/MEMBER)
(505) 870-9647
Entity
Organization
Contact information
Practice address
1211 E AZTEC AVE, GALLUP, NM 87301-4901
(505) 870-9647
Mailing address
1070 RANCHO RD, GALLUP, NM 87301-7036
(505) 870-9647
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
97-60
NM
2084N0400X
Neurology Physician
Primary
97-23
NM
2084N0600X
Clinical Neurophysiology Physician
97-23
NM
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
97-23
NM
Other
Enumeration date
04/29/2011
Last updated
10/28/2011
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