Provider Demographics
NPI:1407668494
Name:MUNIZ-GALLEGOS, LEONARDO SEBASTIAN
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:SEBASTIAN
Last Name:MUNIZ-GALLEGOS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 I ST.
Mailing Address - Street 2:STE. 200, 2ND FL.
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354
Mailing Address - Country:US
Mailing Address - Phone:888-376-6246
Mailing Address - Fax:
Practice Address - Street 1:1601 I ST.
Practice Address - Street 2:STE. 200, 2ND FL.
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354
Practice Address - Country:US
Practice Address - Phone:888-376-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)