Healthcare Provider Details

I. General information

NPI: 1598722050
Provider Name (Legal Business Name): VINCENT NICHOLAS GALLUZZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 FLORIDA AVE SUITE 201
MODESTO CA
95350-4400
US

IV. Provider business mailing address

PO BOX 12060
LAS VEGAS NV
89112-0060
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4384
  • Fax: 209-526-4385
Mailing address:
  • Phone: 702-360-2100
  • Fax: 909-557-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG19217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: