Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | F000486-1 | NY |
NPI | 1083883979 |
---|---|
Provider Name | Juanita Gallegos |
First Address | Bronx, NY 10462-1236 |
Second Address | Bronx, NY 10462-1236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2008 |
Last Update Date | 01/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01779886 | (05) | NY |