Provider Demographics
NPI:1295327914
Name:GALLEGO, NEVADA (PA-C)
Entity type:Individual
Prefix:
First Name:NEVADA
Middle Name:
Last Name:GALLEGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NEVADA
Other - Middle Name:
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:18801 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2826
Mailing Address - Country:US
Mailing Address - Phone:754-544-9030
Mailing Address - Fax:754-241-2981
Practice Address - Street 1:18801 NE 29TH AVE
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2826
Practice Address - Country:US
Practice Address - Phone:754-544-9030
Practice Address - Fax:754-241-2981
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant