Provider Demographics
NPI:1376258392
Name:GALLO, ANA-MARIA
Entity Type:Individual
Prefix:
First Name:ANA-MARIA
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 1:11908 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4327
Mailing Address - Country:US
Mailing Address - Phone:858-705-6036
Mailing Address - Fax:
Practice Address - Street 1:11908 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4327
Practice Address - Country:US
Practice Address - Phone:619-857-4438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405364S00000X
CA456555163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient