Provider Demographics
NPI:1841992278
Name:GALLO MARIN, BENJAMIN ANDRES
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ANDRES
Last Name:GALLO MARIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 BROADWAY STREET
Mailing Address - Street 2:PAVILION C, 2ND FLOOR, MC 5334
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-723-5948
Mailing Address - Fax:
Practice Address - Street 1:450 BROADWAY STREET
Practice Address - Street 2:PAVILION C, 2ND FLOOR, MC 5334
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-723-5948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program