Healthcare Provider Details

I. General information

NPI: 1629930557
Provider Name (Legal Business Name): BAILEE NICOLE GALLEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5773 W 118TH PL
WESTMINSTER CO
80020-5927
US

IV. Provider business mailing address

5773 W 118TH PL
WESTMINSTER CO
80020-5927
US

V. Phone/Fax

Practice location:
  • Phone: 720-545-7062
  • Fax:
Mailing address:
  • Phone: 720-545-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: