MEDICARE: MIA GABRIELLA GALASSI CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	95001564	CA

General Provider Information

NPI Number	:	1013582055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA GABRIELLA GALASSI CRNA

Provider Business Mailing Address
First Line	:	2435 AVENIDA MASTIL
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-3637
Country	:	US
Telephone Number	:	949-412-4285
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 836 BOX 2670
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09636-9998
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	06/11/2026

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