Provider Demographics
NPI:1205247202
Name:GALLETTA, MARIE (LAC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GALLETTA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-391-9995
Mailing Address - Fax:
Practice Address - Street 1:203 S SCHOOL ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4827
Practice Address - Country:US
Practice Address - Phone:707-391-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2015-10-08
Deactivation Date:2014-06-16
Deactivation Code:
Reactivation Date:2015-09-22
Provider Licenses
StateLicense IDTaxonomies
CA15963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist