Provider Demographics
NPI:1790881506
Name:GALLOWAY, CARLA GALE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:GALE
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1426 FRONTERO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5915
Mailing Address - Country:US
Mailing Address - Phone:650-949-1863
Mailing Address - Fax:650-949-1863
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:11C/C&P
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG385002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF92071Medicare UPIN