Healthcare Provider Details

I. General information

NPI: 1598466724
Provider Name (Legal Business Name): STEPHANIE ROSE GALLETO LAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 G ST STE F
MERCED CA
95340-0978
US

IV. Provider business mailing address

3349 G ST STE F
MERCED CA
95340-0978
US

V. Phone/Fax

Practice location:
  • Phone: 209-349-8459
  • Fax: 209-580-4138
Mailing address:
  • Phone: 209-349-8459
  • Fax: 209-580-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02231158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: