Healthcare Provider Details

I. General information

NPI: 1588926893
Provider Name (Legal Business Name): CYNTHIA V. GALLEGOS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 VILLA AVE SUITE 3 & 28
CLOVIS CA
93612-7605
US

IV. Provider business mailing address

516 VILLA AVE SUITE 3 & 28
CLOVIS CA
93612-7605
US

V. Phone/Fax

Practice location:
  • Phone: 559-801-2840
  • Fax:
Mailing address:
  • Phone: 559-801-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 52077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: