MEDICARE: MISS ERIN GALLO R.D.

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	133V00000X	Registered Dietitian	1074014	CA

General Provider Information

NPI Number	:	1447524343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERIN GALLO R.D.

Provider Business Mailing Address
First Line	:	2335 ELDEN AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-1592
Country	:	US
Telephone Number	:	949-547-4219
Fax Number	:

Provider Business Practice Location Address
First Line	:	2335 ELDEN AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-1592
Country	:	US
Telephone Number	:	949-547-4219
Fax Number	:

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

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	09/14/2015

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