Provider Demographics
NPI:1427342864
Name:GALLEGOS, ADRIANNA CHRISTINE
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:CHRISTINE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GAUDIAN LOOP
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-9555
Mailing Address - Country:US
Mailing Address - Phone:505-620-2119
Mailing Address - Fax:505-445-4504
Practice Address - Street 1:9 GAUDIAN LOOP
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047-9555
Practice Address - Country:US
Practice Address - Phone:505-620-2119
Practice Address - Fax:505-445-4504
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-099171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical