Provider Demographics
NPI:1861820714
Name:GALLEGOS, NANILII (BS)
Entity Type:Individual
Prefix:
First Name:NANILII
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 CHASE ST.
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212
Mailing Address - Country:US
Mailing Address - Phone:303-903-1391
Mailing Address - Fax:
Practice Address - Street 1:16390 E 14TH PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-7411
Practice Address - Country:US
Practice Address - Phone:303-903-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health