Healthcare Provider Details

I. General information

NPI: 1477004307
Provider Name (Legal Business Name): EMMANUEL VICTOR D GALICIA N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27924 SECO CANYON RD #101
SANTA CLARITA CA
91350-3870
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-513-2100
  • Fax:
Mailing address:
  • Phone: 818-837-5559
  • Fax: 818-792-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: