Healthcare Provider Details

I. General information

NPI: 1235957804
Provider Name (Legal Business Name): MARK GALLO REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

IV. Provider business mailing address

10440 PARAMOUNT BLVD APT F259
DOWNEY CA
90241-2342
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-9530
  • Fax:
Mailing address:
  • Phone: 626-252-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95112500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: