Provider Demographics
NPI:1073892956
Name:GALLEGOS, GUADALUPE LISET (MSW)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:LISET
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:LISET
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18350 MOUNT LANGLEY ST STE 220
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6912
Mailing Address - Country:US
Mailing Address - Phone:714-378-2620
Mailing Address - Fax:
Practice Address - Street 1:18350 MOUNT LANGLEY ST STE 220
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6912
Practice Address - Country:US
Practice Address - Phone:714-378-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA772571041C0700X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical