Healthcare Provider Details

I. General information

NPI: 1114034808
Provider Name (Legal Business Name): KATHLEEN EMILIE GALLAHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17871 SANTIAGO BLVD SUITE 206 FIRST FLOOR
VILLA PARK CA
92861-4141
US

IV. Provider business mailing address

17871 SANTIAGO BLVD SUITE 206 FIRST FLOOR
VILLA PARK CA
92861-4141
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-1362
  • Fax: 714-974-3145
Mailing address:
  • Phone: 714-974-1362
  • Fax: 714-974-3145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: