Provider Demographics
NPI:1366463309
Name:GALLEGOS, MARTA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:C
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4933
Mailing Address - Country:US
Mailing Address - Phone:505-234-2008
Mailing Address - Fax:505-885-1075
Practice Address - Street 1:201 N ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4933
Practice Address - Country:US
Practice Address - Phone:505-234-2008
Practice Address - Fax:505-885-1075
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-33207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine