Provider Demographics
NPI:1104318013
Name:LOUIS GALLIA MD MEDICAL CORP
Entity type:Organization
Organization Name:LOUIS GALLIA MD MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GALLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-570-3088
Mailing Address - Street 1:87 SCRIPPS DR STE #112
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-570-3088
Mailing Address - Fax:916-570-3089
Practice Address - Street 1:87 SCRIPPS DR #112
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-570-3088
Practice Address - Fax:916-570-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery