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General NPI Number Information
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NPI Number | 1992085641
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH GALLEGOS DPM
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Gender | Female
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 9692 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6246
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Country | US
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Telephone | 954-998-4466
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Fax | 305-771-0220
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Provider Business Mailing Address
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Address Line | 2082 SW 164TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-4475
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Country | US
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Telephone | 305-900-5324
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Fax | 305-771-0220
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO3512
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License Number State | FL
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