Provider Demographics
NPI:1376077214
Name:GALLO, NOAH
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:GALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3406
Mailing Address - Country:US
Mailing Address - Phone:415-282-9675
Mailing Address - Fax:415-920-6877
Practice Address - Street 1:1234 INDIANA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3406
Practice Address - Country:US
Practice Address - Phone:415-282-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor