Provider Demographics
NPI:1295190882
Name:GARCIA GALLEGOS, LEANDRO R
Entity Type:Individual
Prefix:
First Name:LEANDRO
Middle Name:R
Last Name:GARCIA GALLEGOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68250 HERMOSILLO RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3649
Mailing Address - Country:US
Mailing Address - Phone:760-464-1200
Mailing Address - Fax:
Practice Address - Street 1:68250 HERMOSILLO RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3649
Practice Address - Country:US
Practice Address - Phone:760-464-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)