Provider Demographics
NPI:1205066370
Name:GALLINA, MARIO ANGELO (LAC)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ANGELO
Last Name:GALLINA
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:100 BUSH ST
Mailing Address - Street 2:STE 1900
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3921
Mailing Address - Country:US
Mailing Address - Phone:415-445-9388
Mailing Address - Fax:415-614-4546
Practice Address - Street 1:100 BUSH ST
Practice Address - Street 2:STE 1900
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3921
Practice Address - Country:US
Practice Address - Phone:415-445-9388
Practice Address - Fax:415-614-4546
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12897171100000X
CAAC12897171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist