Provider Demographics
NPI:1871737999
Name:GALLEGOS, RANDALL RICHARD
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:RICHARD
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 1:42011 4TH ST W STE 1900
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7185
Mailing Address - Country:US
Mailing Address - Phone:661-974-7611
Mailing Address - Fax:
Practice Address - Street 1:42011 4TH ST W STE 1900
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7185
Practice Address - Country:US
Practice Address - Phone:661-974-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator