Healthcare Provider Details

I. General information

NPI: 1508816752
Provider Name (Legal Business Name): MANUEL F GALLEGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N 12TH AVE
ARCADIA FL
34266
US

IV. Provider business mailing address

725 N 12TH AVE
ARCADIA FL
34266-8752
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-1242
  • Fax: 963-491-0466
Mailing address:
  • Phone: 863-494-1242
  • Fax: 963-491-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME76119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: