Provider Demographics
NPI:1932184959
Name:GALLI, RANDI A (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:A
Last Name:GALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2139 E BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0340
Mailing Address - Country:US
Mailing Address - Phone:559-322-6600
Mailing Address - Fax:559-322-3354
Practice Address - Street 1:2139 E BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0340
Practice Address - Country:US
Practice Address - Phone:559-322-6600
Practice Address - Fax:559-322-4625
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43628208200000X, 2086S0105X
CA2312086S0105X
CA51822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E32604Medicare UPIN
CA4034228Medicare ID - Type Unspecified