Healthcare Provider Details

I. General information

NPI: 1528646072
Provider Name (Legal Business Name): MARY N GALLANIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY N BENSON

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 HIDDEN VALLEY RD STE 200
CARLSBAD CA
92011-4219
US

IV. Provider business mailing address

6010 HIDDEN VALLEY RD STE 200
CARLSBAD CA
92011-4219
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-3000
  • Fax: 760-631-3016
Mailing address:
  • Phone: 760-631-3000
  • Fax: 760-631-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDR.0071435
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA209996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: