Provider Demographics
NPI:1649703372
Name:GALLO, YOHANA ROSY
Entity type:Individual
Prefix:MRS
First Name:YOHANA
Middle Name:ROSY
Last Name:GALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 MILTON AVE APT G
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-4344
Mailing Address - Country:US
Mailing Address - Phone:562-846-8882
Mailing Address - Fax:
Practice Address - Street 1:7228 MILTON AVE APT G
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-4344
Practice Address - Country:US
Practice Address - Phone:562-846-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87526126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87526Medicaid