Healthcare Provider Details

I. General information

NPI: 1083085765
Provider Name (Legal Business Name): PRISCILLA ANN GALLEGOS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

4411 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-1008
  • Fax:
Mailing address:
  • Phone: 559-453-1008
  • Fax: 559-453-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number240367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: