Provider Demographics
NPI:1811902232
Name:GIALLO, JOSEPH RONALD (EDD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RONALD
Last Name:GIALLO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:RONALD
Other - Last Name:GIALLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:820 BAY AVE
Mailing Address - Street 2:208
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2140
Mailing Address - Country:US
Mailing Address - Phone:831-475-1323
Mailing Address - Fax:831-477-2034
Practice Address - Street 1:820 BAY AVE
Practice Address - Street 2:208A
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2140
Practice Address - Country:US
Practice Address - Phone:831-475-1323
Practice Address - Fax:831-477-2034
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15522103G00000X, 103TC0700X, 103TF0200X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL115520Medicare PIN