Active NPI
Larisa Gallo, PA-C
- Physician Assistant
- Austin, TX
National Provider Identifier
1013256833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA15748
- Practice address
- 12221 Renfert Way Ste 300
Austin, TX 78758-5453 - Phone
- (512) 873-8900
- Fax
- (512) 873-8913
- NPI assigned
- Feb 14, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA056002 | PA | |
| Physician Assistant | 363A00000X | PA52481 | CA | |
| Physician Assistant | 363A00000X | PA15748 | TX | Primary |
Addresses
Primary practice location
12221 Renfert Way Ste 300
Austin, TX 78758-5453
Mailing address
PO Box 911230
Dallas, TX 75391-1230
Phone (972) 997-8000
Other practice location 1
900 Blake Wilbur Dr
Palo Alto, CA 94304-2201
Phone (650) 498-6004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52481 | CA | MD | Pharmacist |
| PA52481 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stanford Health Care | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Stanford, CA
- NPI 1437292927
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654732800000",
"number": "1013256833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 911230",
"city": "DALLAS",
"state": "TX",
"postal_code": "753911230",
"telephone_number": "972-997-8000",
"fax_number": "972-234-0813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12221 RENFERT WAY STE 300",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787585453",
"telephone_number": "512-873-8900",
"fax_number": "512-873-8913"
}
],
"practiceLocations": [
{
"address_1": "900 Blake Wilbur Dr",
"address_purpose": "LOCATION",
"city": "Palo Alto",
"state": "CA",
"postal_code": "943042201",
"country_code": "US",
"telephone_number": "650-498-6004",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GALLO",
"first_name": "LARISA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-14",
"last_updated": "2022-06-09",
"certification_date": "2022-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA056002",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA52481",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA15748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.