=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124673371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE GALLO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2019
-----------------------------------------------------
Last Update Date | 05/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1717 SOLANO WAY STE 5
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-324-9221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2588
-----------------------------------------------------
City | KINGS BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96143-2588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-324-9221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 89542
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 114400
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------