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General NPI Number Information
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NPI Number | 1730166406
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Entity Type | Individual
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Provider Name | LANA LOUIE A. WANIA-GALICIA MD
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Gender | Female
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 865 PATRIOT DR SUITE 201A
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City | MOORPARK
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State | CA
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Zip | 93021-3407
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Country | US
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Telephone | 805-222-4549
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Fax |
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Provider Business Mailing Address
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Address Line | 530 W LOS ANGELES AVE STE 115, MS 343
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City | MOORPARK
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State | CA
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Zip | 93021-1746
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Country | US
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Telephone | 805-222-4549
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Fax | 805-529-4549
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A80078
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License Number State | CA
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