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General NPI Number Information
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NPI Number | 1548320856
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Entity Type | Individual
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Provider Name | LUPE BEATRIZE GALLEGOS RPA-C
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 462 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-9196
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Country | US
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Telephone | 212-562-2355
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Fax |
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Provider Business Mailing Address
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Address Line | 202 W 107TH ST
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City | NEW YORK
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State | NY
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Zip | 10025-3076
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10931
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License Number State | NY
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