Healthcare Provider Details

I. General information

NPI: 1417618117
Provider Name (Legal Business Name): LIVIA SPEARE GALLI RASMUSSEN OD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIVIA CATHERINE SPEARE GALLI OD, MS

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 SYLVA LN STE H
SONORA CA
95370-5969
US

IV. Provider business mailing address

PO BOX 1184
SAN ANDREAS CA
95249-1184
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-4123
  • Fax: 209-532-6749
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35195TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: