MEDICARE: EVAN GALUSKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1376485920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN GALUSKA

Provider Business Mailing Address
First Line	:	17 TRENT ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-1556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9000
Country	:	US
Telephone Number	:	619-543-6463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ EVAN GALUSKA ” Practice Location

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