Healthcare Provider Details

I. General information

NPI: 1093668733
Provider Name (Legal Business Name): MARTIN RAMIRO GALLEGOS-LUPIAN RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARTIN GALLEGOS RBT

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N DEWITT AVE
CLOVIS CA
93612-1066
US

IV. Provider business mailing address

3909 N FORESTIERE AVE
FRESNO CA
93722-1104
US

V. Phone/Fax

Practice location:
  • Phone: 559-338-5493
  • Fax:
Mailing address:
  • Phone: 559-352-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: