MEDICARE: DANIEL P GALAN CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	CPO02636
2	224P00000X	Prosthetist	CPO02636	CA

General Provider Information

NPI Number	:	1255619318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL P GALAN CPO

Provider Business Mailing Address
First Line	:	3369 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-6814
Country	:	US
Telephone Number	:	951-782-7000
Fax Number	:	951-489-0422

Provider Business Practice Location Address
First Line	:	3369 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-6814
Country	:	US
Telephone Number	:	951-782-7000
Fax Number	:	951-489-0422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2011
Last Update Date	:	07/23/2011

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