Provider Demographics
NPI:1487995130
Name:PALLOTTA, GINA M (PHD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:PALLOTTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 NEWCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95215-9663
Mailing Address - Country:US
Mailing Address - Phone:209-345-2726
Mailing Address - Fax:
Practice Address - Street 1:7650 NEWCASTLE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-9663
Practice Address - Country:US
Practice Address - Phone:209-345-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13627103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist