Healthcare Provider Details

I. General information

NPI: 1104269992
Provider Name (Legal Business Name): HOLLIE GALLAGHER-ZATE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90211-2708
US

IV. Provider business mailing address

2492 E RIVER RD
TUCSON AZ
85718-9552
US

V. Phone/Fax

Practice location:
  • Phone: 310-689-3100
  • Fax:
Mailing address:
  • Phone: 520-722-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number007907
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number007907
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A21698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: