Basic Information
| Provider Information | |||||||||
| NPI: | 1871617241 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DONNA M GALLIK | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8631 W 3RD ST | ||||||||
| Address2: | SUITE1017 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900485901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102895901 | ||||||||
| FaxNumber: | 3102895917 | ||||||||
| Practice Location | |||||||||
| Address1: | 8631 W 3RD ST | ||||||||
| Address2: | SUITE1017 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900485901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102895901 | ||||||||
| FaxNumber: | 3102895917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | GALLIK | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 3102895901 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G80598 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.