Basic Information
| Provider Information | |||||||||
| NPI: | 1205390879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLEGO | ||||||||
| FirstName: | ORVILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8605 VANALDEN AVE | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913244365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182353771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19401 S VERMONT AVE STE A200 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905024418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103236887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 225X00000X | OT21498 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.