Provider Demographics
NPI:1063502110
Name:GALLEGOS, BONNIE JO (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MISS
First Name:BONNIE
Middle Name:JO
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:945 SERENO DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2485
Mailing Address - Country:US
Mailing Address - Phone:707-651-1031
Mailing Address - Fax:
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:KAISER PERMANENTE VALLEJO MEDICAL CENTER
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily