Provider Demographics
NPI:1609593334
Name:GALLEGOS, ALYCIA (FNP)
Entity type:Individual
Prefix:
First Name:ALYCIA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALYCIA
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 CASSANDRA LN
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-7067
Mailing Address - Country:US
Mailing Address - Phone:505-264-4309
Mailing Address - Fax:
Practice Address - Street 1:145 DON PASQUAL RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8841
Practice Address - Country:US
Practice Address - Phone:505-865-4618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily