Provider Demographics
NPI:1225485626
Name:GALLIANI, GINA LIN
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LIN
Last Name:GALLIANI
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 1:99 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1158
Mailing Address - Country:US
Mailing Address - Phone:415-342-0496
Mailing Address - Fax:
Practice Address - Street 1:99 FAWN DR
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1158
Practice Address - Country:US
Practice Address - Phone:415-342-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA20810225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst