Provider Demographics
NPI:1285462432
Name:GALLEGOS, REYES MARIE
Entity type:Individual
Prefix:
First Name:REYES
Middle Name:MARIE
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 1:6600 OAKSHORE DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-7476
Mailing Address - Country:US
Mailing Address - Phone:505-409-1740
Mailing Address - Fax:
Practice Address - Street 1:8317 FRONT BEACH RD STE 23
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-4893
Practice Address - Country:US
Practice Address - Phone:505-409-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician