Healthcare Provider Details

I. General information

NPI: 1225431596
Provider Name (Legal Business Name): MARCELA GALLEGOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 MCPHERSON RD N230
LAREDO TX
78041-6507
US

IV. Provider business mailing address

4 SHADOWBROOK LN
BROWNSVILLE TX
78521-1649
US

V. Phone/Fax

Practice location:
  • Phone: 956-728-8121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: