Provider Demographics
NPI:1346994324
Name:GALLO, ELVIA
Entity Type:Individual
Prefix:
First Name:ELVIA
Middle Name:
Last Name:GALLO
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 1:16795 TRINITY BAY CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-7478
Mailing Address - Country:US
Mailing Address - Phone:951-575-9018
Mailing Address - Fax:
Practice Address - Street 1:4850 PEDLEY RD
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-3966
Practice Address - Country:US
Practice Address - Phone:951-360-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2252181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical