Provider Demographics
NPI:1639612401
Name:GALLEGOS, ALYSSA L (CNM)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:L
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 S TELSHOR BLVD BLDG A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4907
Mailing Address - Country:US
Mailing Address - Phone:575-522-9793
Mailing Address - Fax:575-625-8498
Practice Address - Street 1:2520 S TELSHOR BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4907
Practice Address - Country:US
Practice Address - Phone:575-522-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM721367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife