Provider Demographics
NPI:1093292542
Name:GALVAN, SERGIO (LADAC)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:GALVAN
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 MALL DR STE E
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8194
Mailing Address - Country:US
Mailing Address - Phone:575-522-0660
Mailing Address - Fax:575-522-3151
Practice Address - Street 1:ALT RECOVERY GROUP
Practice Address - Street 2:1141 MALL DRIVE SUITE E
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-522-0660
Practice Address - Fax:575-522-3151
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0086771101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)