Individual
MANUELA GALLEGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4100 HIGH RESORT BLVD SE, ALBUQUERQUE, NM 87124-5901
(505) 462-8809
(505) 462-8468
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2007-0025
NM
363AM0700X
Medical Physician Assistant
PA20070025
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243873
—
NM
Enumeration date
10/01/2007
Last updated
08/31/2021
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