Healthcare Provider Details

I. General information

NPI: 1285617779
Provider Name (Legal Business Name): PATRICIA E. GALLEGOS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9320
US

IV. Provider business mailing address

PO BOX 22075
MILWAUKIE OR
97269-2075
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-4988
  • Fax: 503-698-4018
Mailing address:
  • Phone: 503-659-4777
  • Fax: 503-652-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO18778
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: