Healthcare Provider Details

I. General information

NPI: 1013352038
Provider Name (Legal Business Name): GERARDO MORA GALANO RN, BSN, PHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 SHERMAN DR
CHULA VISTA CA
91911-6928
US

IV. Provider business mailing address

1539 SHERMAN DR
CHULA VISTA CA
91911-6928
US

V. Phone/Fax

Practice location:
  • Phone: 760-586-5369
  • Fax: 619-271-1820
Mailing address:
  • Phone: 760-586-5369
  • Fax: 619-271-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberPHN 69298
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberPHN 69298
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberPHN 69298
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberPHN 69298
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberPHN 69298
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberPHN 69298
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberPHN 69298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: