Basic Information
| Provider Information | |||||||||
| NPI: | 1457015208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLEGOS | ||||||||
| FirstName: | GABRIELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3840 WALNUT AVE | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902623635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104932294 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 S LAKE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911013009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264327270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2021 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.