Healthcare Provider Details

I. General information

NPI: 1306454780
Provider Name (Legal Business Name): DAVID EMMANUEL GALLEGOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 185
CONCORD CA
94520-5006
US

IV. Provider business mailing address

636 34TH ST
RICHMOND CA
94805-1752
US

V. Phone/Fax

Practice location:
  • Phone: 510-776-1773
  • Fax:
Mailing address:
  • Phone: 510-776-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: