MEDICARE: MS. ELIZABETH CARBAJAL GALLEGOS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	303230	CA

General Provider Information

NPI Number	:	1730119793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH CARBAJAL GALLEGOS NP

Provider Business Mailing Address
First Line	:	457 LA VERNE ST
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-6015
Country	:	US
Telephone Number	:	909-792-7776
Fax Number	:

Provider Business Practice Location Address
First Line	:	69175 RAMON RD
Second Line	:	BUILDING A
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3344
Country	:	US
Telephone Number	:	619-344-2819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/20/2017

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