Healthcare Provider Details

I. General information

NPI: 1477386811
Provider Name (Legal Business Name): JULISSA GALLEGOS ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 UNION ST
OAKLAND CA
94607-2236
US

IV. Provider business mailing address

540 W GRANT ST
RIALTO CA
92376-7326
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-8000
  • Fax:
Mailing address:
  • Phone: 909-301-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: