Provider Demographics
NPI:1578136388
Name:GALLIN, ELIZA (CNIM)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:GALLIN
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 SOUTHWEST FWY STE 410
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7422
Mailing Address - Country:US
Mailing Address - Phone:713-255-5097
Mailing Address - Fax:469-453-3374
Practice Address - Street 1:4141 SOUTHWEST FWY STE 410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7422
Practice Address - Country:US
Practice Address - Phone:713-255-5097
Practice Address - Fax:469-453-3374
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3171246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3171OtherCNIM