Provider Demographics
NPI:1174369748
Name:GALLINA, MARIA ANTONELLA (INDEPENDENT DUTY)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANTONELLA
Last Name:GALLINA
Suffix:
Gender:F
Credentials:INDEPENDENT DUTY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 HALBERNS BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1431
Mailing Address - Country:US
Mailing Address - Phone:856-266-3158
Mailing Address - Fax:
Practice Address - Street 1:9710 HALBERNS BLVD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-1431
Practice Address - Country:US
Practice Address - Phone:856-266-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman