Provider Demographics
NPI:1922141399
Name:GALLEGOS, DAVID FERMIN (ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FERMIN
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 SANTA INEZ
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4160
Mailing Address - Country:US
Mailing Address - Phone:505-532-8080
Mailing Address - Fax:
Practice Address - Street 1:6301 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-8597
Practice Address - Country:US
Practice Address - Phone:505-882-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer