Provider Demographics
NPI:1073280376
Name:GALLEGOS, SAPPHIRE ANGEL
Entity Type:Individual
Prefix:
First Name:SAPPHIRE
Middle Name:ANGEL
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GRADISHAR PL
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-4161
Mailing Address - Country:US
Mailing Address - Phone:719-242-6976
Mailing Address - Fax:
Practice Address - Street 1:9 GRADISHAR PL
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-4161
Practice Address - Country:US
Practice Address - Phone:719-242-6976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program