Healthcare Provider Details

I. General information

NPI: 1255619318
Provider Name (Legal Business Name): DANIEL P GALAN CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2011
Last Update Date: 07/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3369 CHICAGO AVE
RIVERSIDE CA
92507-6814
US

IV. Provider business mailing address

3369 CHICAGO AVE
RIVERSIDE CA
92507-6814
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-7000
  • Fax: 951-489-0422
Mailing address:
  • Phone: 951-782-7000
  • Fax: 951-489-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO02636
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: