Provider Demographics
NPI:1407105067
Name:GALLEGOS, VALERIE MERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:MERRY
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 N RAYMOND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1891
Mailing Address - Country:US
Mailing Address - Phone:818-433-8609
Mailing Address - Fax:
Practice Address - Street 1:12291 WASHINGTON BLVD STE 500
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2551
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-789-4339
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA131059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program