Provider Demographics
NPI:1669772760
Name:GALLEGOS, ROBERT ANDREW JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANDREW
Last Name:GALLEGOS
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:716 E MISSION BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-7203
Mailing Address - Country:US
Mailing Address - Phone:909-865-2332
Mailing Address - Fax:909-865-0265
Practice Address - Street 1:2251 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2601
Practice Address - Country:US
Practice Address - Phone:714-449-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2024-09-10
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Provider Licenses
StateLicense IDTaxonomies
CA21273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant