Provider Demographics
NPI:1326295676
Name:GALLEGOS, YAMMILE CEBALLOS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YAMMILE
Middle Name:CEBALLOS
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7614 ROCIO DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6550
Mailing Address - Country:US
Mailing Address - Phone:956-795-8393
Mailing Address - Fax:956-795-8396
Practice Address - Street 1:7305 SAN DARIO AVE
Practice Address - Street 2:SUITE G #125
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-7295
Practice Address - Country:US
Practice Address - Phone:956-795-8393
Practice Address - Fax:956-795-8396
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05879363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program