Healthcare Provider Details

I. General information

NPI: 1972522753
Provider Name (Legal Business Name): VIRGINIA GALAN-BURNS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 15TH ST 1502
SANTA MONICA CA
90404-1135
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-656-1702
  • Fax: 310-458-1061
Mailing address:
  • Phone: 310-301-3873
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: