| Doctor Name: | REBECCA GEBALLE |
| NPI Number: | 1104973403 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AA |
| License Number: | AA2009-001 |
| Business Practice Address: | 933 Bradbury Se Suite 2222 Albuquerque, NM - 871062719 |
| Business Phone Number: | 5052723120 |
| Business Fax Number: | 5052728060 |
| Mailing Address: | 2211 Lomas Blvd Ne, Msc 10 6000 ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871062719 |
| Phone Number: | 5052722610 |
| Fax Number: | 5052721300 |
| NPI Enumeration Date: | 01/05/2007 |
| NPI Last Update Date: | 02/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | AA2009-001 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |