Healthcare Provider Details

I. General information

NPI: 1124003165
Provider Name (Legal Business Name): RANDI A GALLI MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 E BEECHWOOD AVE
FRESNO CA
93720-0340
US

IV. Provider business mailing address

2139 E BEECHWOOD AVE
FRESNO CA
93720-0340
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-6600
  • Fax: 559-322-4625
Mailing address:
  • Phone: 559-322-6600
  • Fax: 559-322-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN ROBERT LOPEZ
Title or Position: CIO
Credential:
Phone: 559-322-6600