Provider Demographics
NPI:1487853263
Name:GALLUP, CECILY JULIA (MD)
Entity type:Individual
Prefix:DR
First Name:CECILY
Middle Name:JULIA
Last Name:GALLUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8771
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:514 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3036
Practice Address - Country:US
Practice Address - Phone:310-937-8555
Practice Address - Fax:310-937-8556
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA108236208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics