Provider Demographics
NPI:1285182741
Name:GRINE-GALLARDO, REINA
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:GRINE-GALLARDO
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:PO BOX 14044
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-4044
Mailing Address - Country:US
Mailing Address - Phone:505-410-2885
Mailing Address - Fax:
Practice Address - Street 1:10116 CHAPALA CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4920
Practice Address - Country:US
Practice Address - Phone:505-410-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist