Provider Demographics
NPI:1447524343
Name:GALLO, ERIN (RD)
Entity type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 ELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1592
Mailing Address - Country:US
Mailing Address - Phone:949-547-4219
Mailing Address - Fax:
Practice Address - Street 1:2335 ELDEN AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1592
Practice Address - Country:US
Practice Address - Phone:949-547-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1074014133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered