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General NPI Number Information
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NPI Number | 1821213323
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Entity Type | Organization
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Legal Business Name | MANUEL GALLEGO MD PA
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3466 DEPEW AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-7015
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Country | US
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Telephone | 941-764-6300
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Fax | 941-764-7297
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Provider Business Mailing Address
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Address Line | PO BOX 510298
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City | PUNTA GORDA
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State | FL
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Zip | 33951-0298
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Country | US
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Telephone | 41-764-6300
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Fax | 941-764-7297
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PROF. LYNNE PARKER GALLEGO
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Credential | MBA
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Telephone | 941-764-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0076119
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | MH0004146
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License Number State | FL
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