Provider Demographics
NPI:1710749668
Name:GALLEGOS, POOJA SHAH (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:SHAH
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CALIFORNIA CT
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4098
Mailing Address - Country:US
Mailing Address - Phone:213-458-2722
Mailing Address - Fax:
Practice Address - Street 1:24452 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3604
Practice Address - Country:US
Practice Address - Phone:949-837-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist