Provider Demographics
NPI:1992085641
Name:GALLEGOS, SUSAN ELIZABETH (DPM)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:2082 SW 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4475
Mailing Address - Country:US
Mailing Address - Phone:305-900-5324
Mailing Address - Fax:305-771-0220
Practice Address - Street 1:9692 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6246
Practice Address - Country:US
Practice Address - Phone:954-998-4466
Practice Address - Fax:305-771-0220
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3512213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist