Provider Demographics
NPI:1407075591
Name:GALLEGOS-WHITE, JESSICA (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GALLEGOS-WHITE
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3734
Mailing Address - Country:US
Mailing Address - Phone:360-990-8877
Mailing Address - Fax:360-874-7707
Practice Address - Street 1:513 BAY ST STE 2
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5301
Practice Address - Country:US
Practice Address - Phone:360-990-8877
Practice Address - Fax:360-874-7707
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60992239171100000X
WAMA00007705225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist