Provider Demographics
NPI:1962163246
Name:GALA, VINNY
Entity type:Individual
Prefix:DR
First Name:VINNY
Middle Name:
Last Name:GALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10916 ASHTON AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4871
Mailing Address - Country:US
Mailing Address - Phone:713-478-2663
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1921
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1826
Practice Address - Country:US
Practice Address - Phone:773-692-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0334461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice