Healthcare Provider Details

I. General information

NPI: 1306524715
Provider Name (Legal Business Name): AMELIA GALLEGOS-ONTIVEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E 4TH ST STE 200&205
SANTA ANA CA
92705-3916
US

IV. Provider business mailing address

2001 E 4TH ST STE 200&205
SANTA ANA CA
92705-3916
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-8140
  • Fax:
Mailing address:
  • Phone: 714-824-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: