Healthcare Provider Details

I. General information

NPI: 1811470925
Provider Name (Legal Business Name): COURTNEY GALLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

IV. Provider business mailing address

2075 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-9222
  • Fax: 949-579-2906
Mailing address:
  • Phone: 949-760-9222
  • Fax: 949-579-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: