Provider Demographics
NPI:1952168114
Name:GALLEGOS, DAVID ENIS (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ENIS
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 N 87TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3689
Mailing Address - Country:US
Mailing Address - Phone:480-546-2819
Mailing Address - Fax:
Practice Address - Street 1:14301 N 87TH ST STE 212
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3689
Practice Address - Country:US
Practice Address - Phone:480-546-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ304630363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health