Healthcare Provider Details

I. General information

NPI: 1306524715
Provider Name (Legal Business Name): AMELIA GALLEGOS-ONTIVEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BEACH BLVD STE 245
BUENA PARK CA
90621-4031
US

IV. Provider business mailing address

6301 BEACH BLVD
BUENA PARK CA
90621-2840
US

V. Phone/Fax

Practice location:
  • Phone: 714-736-0231
  • Fax: 714-736-0231
Mailing address:
  • Phone: 714-736-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: