Provider Demographics
NPI:1598722050
Name:GALLUZZI, VINCENT NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:NICHOLAS
Last Name:GALLUZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12060
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89112-0060
Mailing Address - Country:US
Mailing Address - Phone:702-360-2100
Mailing Address - Fax:909-557-1924
Practice Address - Street 1:1444 FLORIDA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4400
Practice Address - Country:US
Practice Address - Phone:209-526-4384
Practice Address - Fax:209-526-4385
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00437223OtherRAILROAD MEDICARE PTAN
CA00G192170Medicare PIN
CAP00437223OtherRAILROAD MEDICARE PTAN
CABZ038ZMedicare PIN