Dominique J Gallotta, LAC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

AC6769 Issued in CA

Practice address

236 S Larchmont Blvd
Los Angeles, CA 90004-3711

Phone

(323) 377-2072

NPI assigned

Apr 23, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Dominique J Gallotta Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1699119552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 S LARCHMONT BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043711",
            "telephone_number": "323-377-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 S LARCHMONT BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043711",
            "telephone_number": "323-377-2072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLOTTA",
        "first_name": "DOMINIQUE",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-23",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "AC6769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOMINIQUE",
            "last_name": "GALLOTTA",
            "middle_name": "J",
            "prefix": "MS.",
            "credential": "MS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jannely Gallo, MSW
• Mark B Gallo Jr., LMFT
• Matthew Christopher Gallo, MD
• Galloni Enterprises Medical Corporation
• Sarah Gallop, LMFT
• Annika Galloway
• Davell D Galloway
• Mary F Galloway
• Julia Gallucci
• Donna Gallup, LCSW

• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.