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General NPI Number Information
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NPI Number | 1407424211
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Entity Type | Individual
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Provider Name | SEBASTIAN GALLEGO MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 410 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4203
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Country | US
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Telephone | 561-525-1797
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Fax |
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Provider Business Mailing Address
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Address Line | 165 NW 96TH TER APT 105
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6280
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Country | US
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Telephone | 561-525-1797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME171700
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License Number State | FL
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