Healthcare Provider Details

I. General information

NPI: 1871787119
Provider Name (Legal Business Name): MS. MARIA ELENA GALLEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10221 COMPTON AVE 104 &203
WATTS CA
90002-2802
US

IV. Provider business mailing address

10221 COMPTON AVE SUITE 104 AND 203
WATTS CA
90002-2802
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-5100
  • Fax:
Mailing address:
  • Phone: 323-249-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number79398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: