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General NPI Number Information
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NPI Number | 1235957804
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Entity Type | Individual
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Provider Name | MARK GALLO REGISTERED NURSE
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Gender | Male
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 9333 IMPERIAL HWY
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City | DOWNEY
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State | CA
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Zip | 90242-2812
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Country | US
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Telephone | 562-657-9530
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Fax |
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Provider Business Mailing Address
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Address Line | 10440 PARAMOUNT BLVD APT F259
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City | DOWNEY
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State | CA
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Zip | 90241-2342
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Country | US
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Telephone | 626-252-4366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 95112500
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License Number State | CA
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