Provider Demographics
NPI:1528359148
Name:ESPES EST,LLC
Entity Type:Organization
Organization Name:ESPES EST,LLC
Other - Org Name:GALLUP NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLOR
Authorized Official - Middle Name:JARASA
Authorized Official - Last Name:CABALLAR GONZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-870-9647
Mailing Address - Street 1:1070 RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-7036
Mailing Address - Country:US
Mailing Address - Phone:505-870-9647
Mailing Address - Fax:
Practice Address - Street 1:1211 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4901
Practice Address - Country:US
Practice Address - Phone:505-870-9647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-60207RI0200X
NM97-232084N0400X, 2084N0600X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty