Provider Demographics
NPI:1083468839
Name:GALLON, CHANITA
Entity Type:Individual
Prefix:
First Name:CHANITA
Middle Name:
Last Name:GALLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 CAL CENTER DR STE 340
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3225
Mailing Address - Country:US
Mailing Address - Phone:916-671-2646
Mailing Address - Fax:
Practice Address - Street 1:131 STONY CIR STE 1200
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4174
Practice Address - Country:US
Practice Address - Phone:707-576-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker