Healthcare Provider Details

I. General information

NPI: 1033482419
Provider Name (Legal Business Name): SERGIO IVAN GALLEGOZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8300
  • Fax: 661-868-8317
Mailing address:
  • Phone: 661-868-6601
  • Fax: 661-861-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT138873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: