Provider Demographics
NPI:1275808412
Name:GALLO, LINETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINETTE
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10860 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2680
Mailing Address - Country:US
Mailing Address - Phone:305-595-1300
Mailing Address - Fax:305-275-8988
Practice Address - Street 1:10860 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2680
Practice Address - Country:US
Practice Address - Phone:305-595-1300
Practice Address - Fax:305-275-8988
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant