Provider Demographics
NPI:1710695358
Name:GALLEGOS, CASSANDRA RAE (DAC)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:RAE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 W RIORDAN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-0819
Mailing Address - Country:US
Mailing Address - Phone:602-319-2597
Mailing Address - Fax:
Practice Address - Street 1:3640 W RIORDAN RANCH RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-0819
Practice Address - Country:US
Practice Address - Phone:602-319-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ011990171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist