Provider Demographics
NPI:1407043862
Name:GALLAGHER, GINETTE II
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:
Last Name:GALLAGHER
Suffix:II
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 1:286 SO. 16TH STREET
Mailing Address - Street 2:SLO HEALTH DEPARTMENT
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433
Mailing Address - Country:US
Mailing Address - Phone:805-473-7038
Mailing Address - Fax:
Practice Address - Street 1:286 SO. 16TH ST
Practice Address - Street 2:SAN LUIS OBISPO COUNTY HEALTH DEPARTMENT
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433
Practice Address - Country:US
Practice Address - Phone:805-473-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA329742251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare