Provider Demographics
NPI:1831548999
Name:GALLEGOS, RANDI ELISE
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:ELISE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13306 LASSELLE ST
Mailing Address - Street 2:#1075
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-0843
Mailing Address - Country:US
Mailing Address - Phone:951-284-9117
Mailing Address - Fax:
Practice Address - Street 1:13306 LASSELLE ST
Practice Address - Street 2:#1075
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-0843
Practice Address - Country:US
Practice Address - Phone:951-284-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant