Provider Demographics
NPI:1851409577
Name:GALISTEO OB/GYN
Entity Type:Organization
Organization Name:GALISTEO OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:RONKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-992-3290
Mailing Address - Street 1:1691 GALISTEO ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4780
Mailing Address - Country:US
Mailing Address - Phone:505-992-3290
Mailing Address - Fax:
Practice Address - Street 1:1691 GALISTEO ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4780
Practice Address - Country:US
Practice Address - Phone:505-992-3290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0543740001Medicare ID - Type Unspecified