Provider Demographics
NPI:1649699828
Name:GALLI, VANESSA (MD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:GALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:PATTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5373 W LAKE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-8208
Mailing Address - Country:US
Mailing Address - Phone:801-902-8080
Mailing Address - Fax:
Practice Address - Street 1:5373 W LAKE PARK BLVD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-8208
Practice Address - Country:US
Practice Address - Phone:801-902-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9529257-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine