Provider Demographics
NPI:1255684197
Name:GALLEGO, HECTOR JOSE
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:JOSE
Last Name:GALLEGO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:HECTOR
Other - Middle Name:JOSE
Other - Last Name:GALLEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:747 CRANDON BLVD APT 210
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2541
Mailing Address - Country:US
Mailing Address - Phone:305-361-9169
Mailing Address - Fax:
Practice Address - Street 1:747 CRANDON BLVD APT 210
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2541
Practice Address - Country:US
Practice Address - Phone:305-361-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17645207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology