Healthcare Provider Details

I. General information

NPI: 1225485626
Provider Name (Legal Business Name): GINA LIN GALLIANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 FAWN DR
SAN ANSELMO CA
94960-1158
US

IV. Provider business mailing address

99 FAWN DR
SAN ANSELMO CA
94960-1158
US

V. Phone/Fax

Practice location:
  • Phone: 415-342-0496
  • Fax:
Mailing address:
  • Phone: 415-342-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number20810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: