Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports |
NPI | 1003569161 |
---|---|
Provider Name | Angela Gallegos |
First Address | Oxnard, CA 93030-7002 |
Second Address | Oxnard, CA 93030-7002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2022 |
Last Update Date | 30/01/2022 |