Individual
ANTONIO GAGLIASSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
360 36TH AVE, SANTA CRUZ, CA 95062-5551
(831) 332-1616
Mailing address
360 36TH STREET, SANTA CRUZ, CA 95062
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/28/2012
Last updated
03/28/2012
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