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General NPI Number Information
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NPI Number | 1962526806
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Entity Type | Organization
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Legal Business Name | GALLERIA MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 2340 E 8TH ST SUITE J
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2869
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Country | US
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Telephone | 619-479-0320
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Fax | 619-479-0367
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Provider Business Mailing Address
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Address Line | 2340 E 8TH ST SUITE J
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2869
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Country | US
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Telephone | 619-479-0320
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Fax | 619-479-0367
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Authorized Official
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Title or Position | M.D.
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Name | IRINEO D TIANGCO
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Credential | M.D.
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Telephone | 619-479-0320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A52655
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License Number State | CA
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