Provider Demographics
NPI:1144019340
Name:GALLEGOS, ANDRES JAVIER
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:JAVIER
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14726 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8866
Mailing Address - Country:US
Mailing Address - Phone:786-665-1556
Mailing Address - Fax:
Practice Address - Street 1:14726 PORTER RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8866
Practice Address - Country:US
Practice Address - Phone:786-665-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver