Provider Demographics
NPI:1700970191
Name:SANCHEZGALLEGOS, DIANA (CFNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SANCHEZGALLEGOS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:609 S CHRISTOPHER RD
Practice Address - Street 2:PMG BELEN
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87002-2602
Practice Address - Country:US
Practice Address - Phone:505-864-5454
Practice Address - Fax:505-864-5450
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000L6483Medicaid
S54676Medicare UPIN