Healthcare Provider Details

I. General information

NPI: 1376101105
Provider Name (Legal Business Name): LYDONA F GALLIMBA GONZALEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 419
LONG BEACH CA
90806-2775
US

IV. Provider business mailing address

701 E 28TH ST STE 419
LONG BEACH CA
90806-2775
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-9900
  • Fax:
Mailing address:
  • Phone: 562-490-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: