Healthcare Provider Details

I. General information

NPI: 1366919441
Provider Name (Legal Business Name): RENE GALLEGOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 OAK PARK BLVD
PLEASANT HILL CA
94523-4601
US

IV. Provider business mailing address

3206 MOUNT DIABLO ST
CONCORD CA
94518-1148
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-6630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA48778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: