Healthcare Provider Details

I. General information

NPI: 1396194841
Provider Name (Legal Business Name): CASEY GALICIA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 MARGARET LN
WALNUT CA
91789-4548
US

IV. Provider business mailing address

855 MARGARET LN
WALNUT CA
91789-4548
US

V. Phone/Fax

Practice location:
  • Phone: 626-374-4660
  • Fax:
Mailing address:
  • Phone: 626-374-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: