Healthcare Provider Details

I. General information

NPI: 1972426161
Provider Name (Legal Business Name): JENNA GALAN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 SEA WATER LN
SAN DIEGO CA
92154-6413
US

IV. Provider business mailing address

4704 SEA WATER LN
SAN DIEGO CA
92154-6413
US

V. Phone/Fax

Practice location:
  • Phone: 619-587-3049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95040046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: