Provider Demographics
NPI:1699448696
Name:GALLANT- REYES, RAQUEL FLORENCE
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:FLORENCE
Last Name:GALLANT- REYES
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 1:4001 OFFICE COURT DR STE 706
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4958
Mailing Address - Country:US
Mailing Address - Phone:505-577-8360
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DR STE 706
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4958
Practice Address - Country:US
Practice Address - Phone:505-577-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician