Provider Demographics
NPI:1104837129
Name:GALLUS, KATERINA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:MARIA
Last Name:GALLUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATERINA
Other - Middle Name:MARIA
Other - Last Name:LENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8899 UNIVERSITY CENTER LN STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1065
Mailing Address - Country:US
Mailing Address - Phone:858-224-2281
Mailing Address - Fax:858-724-3020
Practice Address - Street 1:8899 UNIVERSITY CENTER LN STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1065
Practice Address - Country:US
Practice Address - Phone:858-224-2281
Practice Address - Fax:858-724-3020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67126208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery